plan directory for medicare advantage, cost, pace,...

Plan Directory

for

Medicare Advantage, Cost,

PACE, and Demonstration

Organizations

Sorted by Legal Entity Name

CPC/MDBG/DPD

September 2015

IMPORTANT NOTES

1. This directory contains information for Medicare Advantage, demonstration, PACE, and cost

organizations that have an active contract with CMS at the time of the directory’s publication.

2. These data have been extracted from the Health Plan Management System (HPMS),

maintained by the Center for Drug and Health Plan Choice/Medicare Drug Benefit and C & D

Data Group/Division of Plan Data (CPC/MDBG/DPD).

3. This directory will be updated on a monthly basis.

4. The plan directory contact data is maintained by each organization in HPMS. If an organization

needs to update its contact data, the plan user should use the following navigation path in

HPMS: HPMS Homepage > Contract Management > Contract Management > Select a Contract

Number > Contact Data > Plan Directory Contact for Public Website.

5. The enrollment number displayed in this directory has been pulled from the “Monthly Enrollment

by Contract” file posted on the CMS public website at:

http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/02_EnrollmentData.asp

6. This enrollment number represents the number of enrollees for which the contract received

payment for the month.

7. As asterisk in place of the enrollment number indicates that the count is less than 10.

8. Pilot contracts are excluded from this directory.

September 2015 Contract Directory Sorted by Legal Entity Name of 196

Legal Entity Name: A&D CHARITIBLE

FOUNDATION, INC. Contract Number: H9185 Organization Marketing Name: Great Lakes PACE

Parent Organization: A&D Charitable Foundation,

Inc.

Organization Type: National PACE Contact Title: Program Director Plan Type: National PACE Name: David Benjamin

Contract Effective Date: 05/01/2015 Phone: 1-989-249-0929 Tax Status: Not-for-Profit/Non-Profit Extension:

CMS Region Responsible: Chicago Fax: 1-989-249-1147 Enrollment: 14 Email: [email protected]

Address: 3150 Enterprise Dr, Legal Entity Address: 3150 Enterprise Drive, #200

City: Saginaw City: Saginaw State: MI

State: MI Zip: 48603 Zip: 48603 Last Updated: 11/12/2014

Legal Entity Name: ABSOLUTE TOTAL CARE, INC.

Contract Number: H1723 Organization Marketing Name: Absolute Total Care

Parent Organization: Centene Corporation

Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Member Services

Contract Effective Date: 02/01/2015 Phone: 1-855-735-4398 Tax Status: For Profit Extension:

CMS Region Responsible: Atlanta Fax: Enrollment: 531 Email: [email protected]

Address: 1441 Main Street Legal Entity Address: 1441 Main Street Suite 900

Suite 900 City: Columbia City: Columbia State: SC

State: SC Zip: 29201 Zip: 29201 Last Updated: 03/04/2015

Legal Entity Name: ADVANTAGE HEALTH

SOLUTIONS, INC. Contract Number: H5508 Organization Marketing Name: ADVANTAGE Health

Solutions, Inc. Parent Organization: Advantage

Health Solutions

Organization Type: Local CCP Contact Title: CCO Plan Type: Local PPO Name: Jan Teal


CMS Region Responsible: Chicago Fax: 1-317-587-8408 Enrollment: 20,976 Email: [email protected]

Address: 9045 River Road, Suite 200 Legal Entity Address: 9045 River Road, Suite 200

City: Indianapolis City: Indianapolis State: IN

State: IN Zip: 46240 Zip: 46240 Last Updated: 04/12/2013

Legal Entity Name: ADVANTAGE HEALTH

SOLUTIONS, INC. Contract Number: H8822 Organization Marketing Name: ADVANTAGE Health

Solutions, Inc. Parent Organization: Advantage

Health Solutions

Organization Type: Local CCP Plan Type: HMO/HMOPOS

Contract Effective Date: 01/01/2009 Tax Status: For Profit

CMS Region Responsible: Chicago Enrollment: 1,340

Legal Entity Address: 9045 River Road, Suite 200

City: Indianapolis State: IN

Zip: 46240

Contact Title: CCO Name: Jan Teal Phone: 1-317-573-8250

Extension: Fax: 1-317-587-8408

Email: [email protected] Address: 9045 River Road, Suite 200


Zip: 46240 Last Updated: 04/12/2013


Legal Entity Name: ADVICARE, CORP. Contract Number: H7542

Organization Marketing Name: Advicare Advocate Parent Organization: Spartanburg Regional Health

Services District, Inc

Organization Type: Demo Contact Title: Manager of Customer Service Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Gregory Ross

Contract Effective Date: 02/01/2015 Phone: 1-888-781-4371 Tax Status: For Profit Extension: 248

CMS Region Responsible: Atlanta Fax: 1-888-781-4316 Enrollment: 600 Email: [email protected]

Address: 531 S Main Street, Suite RL-

1 Legal Entity Address: 531 South Main Street, Suite RL-1

City: Greenville City: Greenville State: SC


Legal Entity Name: AETNA BETTER HEALTH OF

MICHIGAN INC. Contract Number: H8026 Organization Marketing Name: Aetna Better Health Premier

Plan Parent Organization: Aetna Inc.

Organization Type: Demo Contact Title: Compliance Officer Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Eric W Campbell



Address: 333 W Wacker Drive Legal Entity Address: 1333 Gratiot Avenue, Suite 400 Suite 2100

City: Chicago City: Detroit State: IL


Legal Entity Name: AETNA BETTER HEALTH, INC. (IL)

Contract Number: H2506 Organization Marketing Name: Aetna Better Health Premier Plan

Parent Organization: Aetna Inc.


HMO/HMOPOS Name: Eric W Campbell



Address: 1 South Wacker Drive Legal Entity Address: 333 West Wacker Dr.

Suite 2100, MC F646 City: Chicago City: Chicago State: IL

State: IL Zip: 60606 Zip: 60606 Last Updated: 09/23/2014

Legal Entity Name: AETNA BETTER HEALTH, INC. (NY)

Contract Number: H8056 Organization Marketing Name: Aetna Better Health FIDA Plan


Organization Type: Demo Contact Title: Sr. Compliance Lead


Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Dennis Norton


CMS Region Responsible: New York Fax: Enrollment: 105 Email: [email protected]

Address: 55 W. 125th Street Legal Entity Address: 55 West 125th Street, Suite 1300 Suite 1300 City: New

York City: New York, State: NY

State: NY Zip: 10027 Zip: 10027 Last Updated: 07/08/2015

Legal Entity Name: AETNA BETTER HEALTH, INC.

(OH) Contract Number: H7172 Organization Marketing Name: Aetna Better Health of Ohio,

MyCare Ohio Parent Organization: Aetna Inc.

Organization Type: Demo Contact Title: Sr. Director Medicare Relations Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Jason Smith


CMS Region Responsible: Chicago Fax: Enrollment: 13,796 Email: [email protected]

Address: 7400 West Campus

Road Legal Entity Address: 7400 W Campus Rd

City: New Albany City: New Albany State: OH

State: OH Zip: 43054 Zip: 43054 Last Updated: 07/08/2015

Legal Entity Name: AETNA HEALTH

INC.(GEORGIA) Contract Number: H1109 Organization Marketing Name: Aetna Medicare


Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Aetna Customer Service


CMS Region Responsible: Denver Fax: Enrollment: 3,403 Email: [email protected]

Address: 151 Farmington Avenue Legal Entity Address: 11675 Great Oaks Way

City: Hartford City: Alpharetta State: CT

State: GA Zip: 06156 Zip: 30022 Last Updated: 08/11/2015

Legal Entity Name: AETNA HEALTH OF

CALIFORNIA INC. Contract Number: H0523 Organization Marketing Name: Aetna

Medicare Parent Organization: Aetna

Inc.




Address: 151 Farmington Avenue


Legal Entity Address: 2409 CAMINO RAMON City: Hartford

City: SAN RAMON State: CT State: CA Zip: 06156

Zip: 94583 Last Updated: 08/11/2015 Legal Entity Name: AETNA HEALTH OF UTAH,

INC. Contract Number: H8649 Organization Marketing Name: Altius Health Plans





Address: 151 Farmington Avenue Legal Entity Address: 10150 S Centennial Parkway

Suite 450 City: Hartford City: Sandy State: CT

State: UT Zip: 06156 Zip: 84070 Last Updated: 08/12/2015

Legal Entity Name: AETNA HEALTH, INC, (PA) Contract

Number: H3931 Organization Marketing Name: Aetna Medicare Parent

Organization: Aetna Inc.




Address: 151 Farmington Avenue Legal Entity Address: 980 Jolly Road

City: Hartford City: Blue Bell State: CT

State: PA Zip: 06156 Zip: 19422 Last Updated: 08/11/2015

Legal Entity Name: AETNA HEALTH, INC. Contract Number: H1609

Organization Marketing Name: Coventry Health Care Parent Organization: Aetna Inc.




Address: 151 Farmington Avenue Legal Entity Address: 4320 114th Street

City: Hartford City: Urbandale State: CT

State: IA Zip: 06156 Zip: 50322 Last Updated: 11/26/2014

Legal Entity Name: AETNA HEALTH, INC. Contract Number: H3928

Organization Marketing Name: Coventry Health Care Parent Organization: Aetna Inc.

Organization Type: Local CCP Contact Title:


Plan Type: HMO/HMOPOS Name: Aetna Customer Service Contract Effective Date: 01/01/2014 Phone: 1-888-360-6626

Tax Status: For Profit Extension: CMS Region Responsible: Denver Fax:

Enrollment: 1,439 Email: [email protected] Address: 151 Farmington Avenue

Legal Entity Address: 3838 N. Causeway Blvd Suite 3350 City: Hartford

City: Metairie State: CT State: LA Zip: 06156

Zip: 70002 Last Updated: 11/25/2014 Legal Entity Name: AETNA HEALTH, INC. (CT) Contract

Number: H5793 Organization Marketing Name: Aetna Medicare Parent

Organization: Aetna Inc.



CMS Region Responsible: Denver Enrollment: 22,451

Legal Entity Address: 151 Farmington Avenue

City: Hartford State: CT

Zip: 06156

Contact Title: Name: Aetna Customer Service Phone: 1-800-624-0756 Extension: Fax: Email: [email protected] Address: 151

Farmington Avenue



Legal Entity Name: AETNA HEALTH, INC.

(FL) Contract Number: H5414 Organization Marketing Name: Aetna Medicare





Address: 151 Farmington Avenue Legal Entity Address: 4630 Woodlands

Corporate Blvd. City: Hartford City: Tampa State: CT

State: FL Zip: 06156 Zip: 33614 Last Updated: 08/11/2015


(GEORGIA) Contract Number: H5302 Organization Marketing Name: Coventry Health Care





Address: 151 Farmington Avenue Legal Entity Address: 1100 Circle 75 Parkway,

Suite 1400 City: Hartford City: Atlanta State: CT

State: GA Zip: 06156


Zip: 30339 Last Updated: 08/11/2015 Legal Entity Name: AETNA HEALTH, INC.

(ME) Contract Number: H3597 Organization Marketing Name: Aetna Medicare





Address: 151 Farmington Avenue Legal Entity Address: 151 Farmington Avenue

City: Hartford City: Hartford State: CT

State: CT Zip: 06156 Zip: 06156 Last Updated: 08/11/2015


(NJ) Contract Number: H3152 Organization Marketing Name: Aetna Medicare





Legal Entity Address: 55 LANE ROAD

City: FAIRFIELD State: NJ

Zip: 070041098

Contact Title: Name: Aetna Customer Service Phone: 1-800-624-0756

Extension: Fax: Email: [email protected]




Legal Entity Name: AETNA HEALTH, INC. (NY)

Contract Number: H3312 Organization Marketing Name: Aetna Medicare





Address: 151 Farmington Avenue Legal Entity Address: 99 PARK AVENUE

City: Hartford City: NEW YORK State: CT


Legal Entity Name: AETNA HEALTH, INC. (TX)

Contract Number: H4523 Organization Marketing Name: Aetna Medicare




CMS Region Responsible: Denver Fax:


Enrollment: 12,471 Email: [email protected] Address: 151 Farmington Avenue

Legal Entity Address: 2777 Stemmons Freeway

Suite 300 City: Hartford City: Dallas State: CT

State: TX Zip: 06156 Zip: 753569440 Last Updated: 08/11/2015

Legal Entity Name: AETNA LIFE INSURANCE

COMPANY Contract Number: H5521 Organization Marketing Name: Aetna

Medicare Parent Organization: Aetna

Inc.

Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Aetna Customer Service



Address: 151 Farmington Avenue Legal Entity Address: 980 Jolly Road

City: Hartford City: Blue Bell State: CT


Legal Entity Name: AFFINITY HEALTH PLAN,

INC. Contract Number: H5991 Organization Marketing Name: Affinity Health Plan

Parent Organization: Affinity Health Services

Holdings, Inc.


Contract Effective Date: 01/01/2007 Tax Status: Not-for-Profit/Non-Profit

CMS Region Responsible: New York Enrollment: 7,485

Legal Entity Address: 1776 Eastchester Road

City: Bronx State: NY

Zip: 10461

Contact Title: Manager, Customer

Service Name: Alvin Ortiz Phone: 1-718-794-

6288 Extension: Fax: Email: [email protected]

Address: 1776 Eastchester Road

City: Bronx State: NY


Legal Entity Name: AGEWELL NEW YORK, LLC

Contract Number: H4922 Organization Marketing Name: AgeWell New York

Parent Organization: AgeWell New York, LLC

Organization Type: Local CCP Contact Title: Associate Executive Director Plan Type: HMO/HMOPOS Name: Dana Sherwin



Address: 1991 Marcus Ave Legal Entity Address: 1991 Marcus Avenue Suite M201

Suite M201 City: Lake Success City: Lake Success State: NY



Legal Entity Name: AGEWELL NEW YORK, LLC

Contract Number: H6308 Organization Marketing Name: AgeWell New York FIDA

Plan Parent Organization: ParkerCare New York, LLC

Organization Type: Demo Contact Title: Associate Executive Director Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Dana Sherwin



Address: 1991 Marcus Ave Legal Entity Address: 1991 Marcus Avenue Suite M201

Suite M201 City: Lake Success City: Lake Success State: NY


Legal Entity Name: AHF MCO OF FLORIDA, INC.

Contract Number: H3132 Organization Marketing Name: AHF

Parent Organization: AIDS Healthcare Foundation

Organization Type: Local CCP Contact Title: Health Plan Administrator Plan Type: HMO/HMOPOS Name: Michael O'Malley


CMS Region Responsible: San Francisco Fax: 1-323-337-9141 Enrollment: 1,261 Email: [email protected]

Address: 1001 N. Martel Ave. Legal Entity Address: 700 SE 3rd Ave., 4th Floor

City: Los Angeles City: Fort Lauderdale State: CA


Legal Entity Name: AIDS HEALTHCARE

FOUNDATION Contract Number: H5852 Organization Marketing Name: AHF

Parent Organization: AIDS Healthcare Foundation

Organization Type: Local CCP Contact Title: Health Plan Administrator Plan Type: HMO/HMOPOS Name: Michael O'Malley

Contract Effective Date: 01/01/2006 Phone: 1-800-263-0067 Tax Status: Not-for-Profit/Non-Profit Extension: 2

CMS Region Responsible: San Francisco Fax: 1-323-337-9141 Enrollment: 830 Email: [email protected]

Address: 1001 N. Martel Ave. Legal Entity Address: 6255 W. Sunset Blvd., 21st

Floor City: Los Angeles City: Los Angeles State: CA

State: CA Zip: 90046 Zip: 90028 Last Updated: 06/13/2013

Legal Entity Name: ALBRIGHT CARE SERVICES

Contract Number: H9068 Organization Marketing Name: ALBRIGHT CARE SERVICES

Parent Organization: Albright Care Services

Organization Type: National PACE Contact Title: Corporate Compliance Officer Plan Type: National PACE Name: LouAnn Shively



CMS Region Responsible: Philadelphia Fax: 1-570-524-9068 Enrollment: 174 Email: [email protected]

Address: 90 Maplewood Drive Legal Entity Address: 90 Maplewood Drive

City: Lewisburg City: Lewisburg State: PA


Legal Entity Name: ALEXIAN BROTHERS COMMUNITY

SERVICES Contract Number: H2609 Organization Marketing Name: Alexian Brothers Community

Services Parent Organization: Acension Health

Organization Type: National PACE Contact Title: Marketing Director Plan Type: National PACE Name: Katina Boykin


CMS Region Responsible: Kansas City Fax: 1-314-771-7830 Enrollment: 169 Email: [email protected]

Address: 3900 S. Grand Legal Entity Address: 3900 S. GRAND BOULEVARD

City: St. Louis City: ST. LOUIS State: MO

State: MO Zip: 63118 Zip: 63118 Last Updated: 05/02/2014

Legal Entity Name: ALEXIAN BROTHERS COMMUNITY

SERVICES Contract Number: H4402 Organization Marketing Name: Alexian Brothers Community

Services Parent Organization: Acension Health

Organization Type: National PACE Contact Title: IT Plan Type: National PACE Name: Shannon Lane



Address: 425 Cumberland Street Legal Entity Address: 425 CUMBERLAND STREET, Suite

110 Suite 110

Suite 110 City: Chattanooga City: CHATTANOOGA State: TN

State: TN Zip: 37404 Zip: 37404 Last Updated: 06/07/2011

Legal Entity Name: ALIGNMENT HEALTH PLAN

Contract Number: H3815 Organization Marketing Name: Alignment Health Plan

Parent Organization: Alignment Healthcare USA, LLC

Organization Type: Local CCP Contact Title: President Plan Type: HMO/HMOPOS Name: Dawn Maroney


CMS Region Responsible: Seattle Fax: 1-844-320-2247 Enrollment: 19,680 Email: [email protected]

Address: 1100 W. Town and Country Road #1600 Legal Entity Address: 1100 W. Town and Country Road

Suite 1600 City: Orange City: Orange State: CA

State: CA Zip: 92868-4600 Zip: 92868 Last Updated: 12/02/2014


Legal Entity Name: ALLEGIAN HEALTH PLANS, INC. Contract

Number: H8554 Organization Marketing Name: Allegian Health Plans

Parent Organization: Tenet Healthcare Corporation



CMS Region Responsible: Dallas Enrollment: 1,846

Legal Entity Address: 2005 Ed Carey Dr

City: Harlingen State: TX

Zip: 78550

Contact Title: Name: Member Services Phone: 1-602-824-3900 Extension:

Fax: Email: [email protected] Address: 7878 N.

16th St., Suite 105

City: Phoenix State: AZ


Legal Entity Name: ALLIANCE HEALTH AND LIFE INSURANCE

COMPANY Contract Number: H2322 Organization Marketing Name: Alliance Medicare PPO

Parent Organization: Henry Ford Health System

Organization Type: Local

CCP Plan Type: Local PPO

Contract Effective Date:

08/01/2005 Tax Status: For Profit


Legal Entity Address: 2850 WEST GRAND BLVD.

City: Detroit State: MI

Zip: 48202

Contact Title: VP-Client Services

Name: Richard Chaney Phone: 1-866-766-


Address: 2850 W. Grand Blvd.

City: Detroit State: MI


Legal Entity Name: ALOHACARE Contract Number: H5969

Organization Marketing Name: AlohaCare Parent

Organization: AlohaCare



CMS Region Responsible: San Francisco Enrollment: 549

Legal Entity Address: 1357 Kapiolani Blvd., Suite 1250

City: Honolulu State: HI

Zip: 96814

Contact Title: Name: AlohaCare Customer Service Phone: 1-808-973-6395 Extension:

Fax: 1-808-973-7410 Email: [email protected]

Address: 1357 Kapiolani Blvd., Suite 1250



Legal Entity Name: ALPHACARE OF NEW YORK, INC.

Contract Number: H6974 Organization Marketing Name: AlphaCare Signature FIDA Plan Parent

Organization: Magellan Health, Inc.


Organization Type: Demo Plan Type: Medicare-Medicaid Plan HMO/HMOPOS


CMS Region Responsible: New York Enrollment: 72

Legal Entity Address: 335 Adams Street Suite 2600

City: Brooklyn State: NY Zip: 11201

Contact Title: Name: Customer Service Phone: 1-855-652-5742


Address: 335 Adams Street Suite 2600

City: Brooklyn State: NY


Legal Entity Name: ALPHACARE OF NEW YORK, INC.

Contract Number: H9122 Organization Marketing Name: AlphaCare of New York, Inc.

Parent Organization: Magellan Health, Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Customer Service


CMS Region Responsible: New York Fax: Enrollment: 1,227 Email: [email protected]

Address: 335 Adams Street Legal Entity Address: 335 Adams Street Suite 2600

Suite 2600 City: Brooklyn City: Brooklyn State: NY


Legal Entity Name: ALTAMED HEALTH SERVICES

CORPORATION Contract Number: H0542 Organization Marketing Name: AltaMed Health Services

Corporation Parent Organization: Altamed Health

Services Corporation

Organization Type: National PACE Contact Title: Vice President, Senior Care Services Plan Type: National PACE Name: Jennifer L Spalding



Address: 2040 Camfield Ave Legal Entity Address: 2040 Camfield Ave.

City: Los Angeles City: Los Angeles State: CA


Legal Entity Name: AMARILLO MULTISVC CTR FR THE

AGING INC Contract Number: H4517 Organization Marketing Name: The basics at Jan Werner

Parent Organization: Amarillo Multisvc Ctr Fr the Aging Inc

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Alana Chilcote


CMS Region Responsible: Dallas Fax: 1-806-373-9446 Enrollment: 137 Email: [email protected]

Address: 3108 S Fillmore Legal Entity Address: 3108 SOUTH FILLMORE STREET

City: Amarillo City: AMARILLO State: TX

State: TX Zip: 79110


Zip: 79110 Last Updated: 05/20/2008 Legal Entity Name: AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY Contract

Number: H2775 Organization Marketing Name: Universal American Corp. Parent

Organization: Universal American Corp. Organization Type: Local CCP Contact Title: Member Services Representative Plan Type: Local PPO Name: Member Services

Contract Effective Date: 01/01/2009 Phone: 1-866-422-5009 Tax Status: For Profit Extension: CMS Region Responsible: Dallas Fax: Enrollment: 11,229 Email: [email protected]

Address: 4888 Loop Central Drive Legal Entity Address: 4888 Loop Central Drive Suite 300 Suite 300 City: Houston City: Houston State: TX State: TX Zip: 77081 Zip: 77081 Last Updated: 04/12/2013

Legal Entity Name: AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY Contract Number:

H2816 Organization Marketing Name: Universal American Corp. Parent Organization:

Universal American Corp. Organization Type: PFFS Contact Title: Member Services Representative Plan Type: PFFS Name: Member Services


Address: 4888 Loop Central Drive Legal Entity Address: 4888 Loop Central Drive Suite 300 Suite 300 City: Houston City: Houston State: TX State: TX Zip: 77081 Zip: 77081 Last Updated: 04/12/2013

Legal Entity Name: AMERICA'S 1ST CHOICE HEALTH PLANS,

INC. Contract Number: H3421 Organization Marketing Name: America's 1st Choice Health Plans, Inc.

Parent Organization: America's 1st Choice Holdings of S.C., LLC

Organization Type: PFFS Contact Title: Associate VP NC/SC/GA Plan Type: PFFS Name: Jane Young


CMS Region Responsible: Atlanta Fax: Enrollment: 3,626 Email: [email protected]

Address: 250 Berryhill Rd Legal Entity Address: 250 Berry Hill Road Suite 311

Suite #311 City: Columbia City: Columbia State: SC


Legal Entity Name: AMERICA'S 1ST CHOICE HEALTH PLANS,

INC. Contract Number: H4738 Organization Marketing Name: America's 1st Choice Health Plans, Inc.

Parent Organization: America's 1st Choice Holdings of S.C., LLC

Organization Type: Local CCP Contact Title: Associate VP NC/SC/GA Plan Type: Local PPO Name: Jane Young


CMS Region Responsible: Atlanta Fax:


Enrollment: 378 Email: [email protected] Address: 250 Berryhill Rd

Legal Entity Address: 250 Berry Hill Road Suite 311 Suite #311 City: Columbia

City: Columbia State: SC State: SC Zip: 29210

Zip: 29210 Last Updated: 09/30/2013 Legal Entity Name: AMERICA'S 1ST CHOICE OF SOUTH

CAROLINA, INC. Contract Number: H8170 Organization Marketing Name: America's 1st Choice of South Carolina

Parent Organization: AmericaÆs 1st Choice of South Carolina, Inc.



CMS Region Responsible: Atlanta Enrollment: 129

Legal Entity Address: 250 Berry Hill Road Suite #311

City: Columbia State: SC

Zip: 29210

Contact Title: Associate VP NC/SC/GA Name: Jane Young Phone: 1-803-748-4533

Extension: 22223

Fax: Email: [email protected]

Address: 250 Berryhill Rd Suite 311



Legal Entity Name: AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC. Contract Number:

H5746 Organization Marketing Name: Amerigroup Community Care of New Mexico Parent

Organization: Anthem Inc. Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Dedicated Services Unit

Contract Effective Date: 01/01/2008 Phone: 1-866-805-4589 Tax Status: For Profit Extension: CMS Region Responsible: Chicago Fax: Enrollment: 2,328 Email: [email protected]

Address: AMERIGROUP Corporation Legal Entity Address: 6565 Americas Parkway NE 4200 West Cypress Street, Suite 900 Suite 110 City: Tampa City: Alburquerque State: FL State: NM Zip: 33607 Zip: 87110 Last Updated: 06/15/2009

Legal Entity Name: AMERIGROUP NEW JERSEY, INC.

Contract Number: H3240 Organization Marketing Name: Amerigroup Community Care Parent

Organization: Anthem Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Dedicated Services Unit


CMS Region Responsible: Chicago Fax: Enrollment: 7,404 Email: [email protected] Address:

AMERIGROUP Corporation Legal Entity Address: 101 Wood Avenue South 4200 West Cypress Street, Suite 900

Suite 800 City: Tampa City: Iselin State: FL

State: NJ Zip: 33607 Zip: 08830 Last Updated: 06/11/2009


Legal Entity Name: AMERIGROUP NEW YORK, LLC

Contract Number: H8417 Organization Marketing Name: Empire BlueCross BlueShield

HealthPlus FIDA Plan Parent Organization: Anthem Inc.

Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Dedicated Services Unit



Address: AMERIGROUP Corporation Legal Entity Address: 9 Pine Street 4200 West Cypress Street, Suite 900

14th Floor City: Tampa City: New York State: FL


Legal Entity Name: AMERIGROUP TENNESSEE, INC.

Contract Number: H7200 Organization Marketing Name: Amerigroup

Parent Organization: Anthem Inc.




Legal Entity Address: 22 Century Boulevard Suite 220

City: Nashville State: TN

Zip: 37214

Contact Title: Name: Dedicated Services Unit Phone: 1-866-805-4589


Address: AMERIGROUP Corporation 4200 West Cypress Street, Suite 900 City:

Tampa State: FL


Legal Entity Name: AMERIGROUP TEXAS, INC.

Contract Number: H5817 Organization Marketing Name: Amerigroup





AMERIGROUP Corporation Legal Entity Address: 3800 Buffalo Speedway 4200 West Cypress Street, Suite 900

Suite 400 City: Tampa City: Houston State: FL


Legal Entity Name: AMERIGROUP TEXAS, INC.

Contract Number: H8786 Organization Marketing Name: Amerigroup STAR+PLUS

MMP Parent Organization: Anthem Inc.


HMO/HMOPOS Name: Dedicated Services Unit


CMS Region Responsible: Dallas Fax:


Enrollment: 19,852 Email: [email protected]

Address: AMERIGROUP Corporation Legal Entity Address: 3800 Buffalo Speedway 4200 West Cypress Street, Suite 900

Suite 400 City: Tampa City: Houston State: FL


Legal Entity Name: AMERIGROUP

WASHINGTON, INC. Contract Number: H1894 Organization Marketing Name: AMERIGROUP





Address: AMERIGROUP Corporation Legal Entity Address: 705 5th Avenue South 4200 West Cypress Street

Suite 300 City: Tampa City: Seattle State: FL

State: WA Zip: 33607 Zip: 98104 Last Updated: 01/25/2013

Legal Entity Name: AMERIHEALTH HMO, INC.

Contract Number: H3156 Organization Marketing Name: AmeriHealth 65 Preferred

HMO Parent Organization: Independence Health Group,

Inc.



CMS Region Responsible: Philadelphia Enrollment: 18,575

Legal Entity Address: 1901 MARKET STREET 45 TH FLOOR

City: PHILADELPHIA State: PA

Zip: 19103



Address: PO Box 7820

City: Philadelphia State: PA

Zip: 19101-7820 Last Updated: 06/05/2015

Legal Entity Name: AMERIHEALTH MICHIGAN, INC. Contract

Number: H0192 Organization Marketing Name: AmeriHealth Caritas VIP Care Plus

Parent Organization: Independence Blue Cross

Organization Type: Demo Contact Title: Director Medicare Customer Service Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Geoffrey Vitrano



Amerihealth Caritas Family of Companies Legal Entity Address: 200 Stevens Drive 200 Stevens Dr City:

Philadelphia City: Philadelphia State: PA



Legal Entity Name: AMIDA CARE INC. Contract Number: H6745

Organization Marketing Name: Amida Care Parent Organization: Amida Care Inc.

Organization Type: Local CCP Contact Title: Director Corporate Publications Plan Type: HMO/HMOPOS Name: Carlos Molina



Address: 14 Penn Plaza, 225 West 34th Street Legal Entity Address: 14 Penn Plaza 2nd floor

2nd floor City: New York City: New York State: NY


Legal Entity Name: ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY Contract Number: H8552 Organization Marketing Name: Anthem Blue Cross Life and Health Insurance Co.


Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Customer Service


Address: 145 S. Pioneer Road Legal Entity Address: 21555 Oxnard Street

City: Fon du Lac City: Woodland Hills State: WI State: CA Zip: 54935 Zip: 91367 Last Updated: 04/05/2013

Legal Entity Name: ANTHEM HEALTH PLANS OF KENTUCKY,

INC. Contract Number: H1849 Organization Marketing Name: Anthem Blue Cross and Blue Shield





Legal Entity Address: 13550 Triton Boulevard

City: Louisville State: KY

Zip: 40223



Address: 145 S. Pioneer Road

City: Fon du Lac State: WI


Legal Entity Name: ANTHEM HEALTH PLANS OF KENTUCKY,

INC. Contract Number: H5530 Organization Marketing Name: Anthem Blue Cross and Blue Shield




CMS Region Responsible: Chicago Fax:


Enrollment: 4,786 Email: [email protected] Address: 145 S. Pioneer Road

Legal Entity Address: 13550 Triton Boulevard City: Fon du Lac

City: Louisville State: WI State: KY Zip: 54935

Zip: 40223 Last Updated: 04/05/2013 Legal Entity Name: ANTHEM HEALTH PLANS OF MAINE, INC.

Contract Number: H6786 Organization Marketing Name: Anthem Blue Cross and Blue Shield




CMS Region Responsible: Chicago Fax: Enrollment: 325 Email: [email protected]

Address: 145 S. Pioneer Road Legal Entity Address: 2 Gannett Drive

City: Fon du Lac City: South Portland State: WI

State: ME Zip: 54935 Zip: 041066911 Last Updated: 04/05/2013

Legal Entity Name: ANTHEM HEALTH PLANS OF MAINE, INC.

Contract Number: H8432 Organization Marketing Name: Anthem Blue Cross and Blue Shield





Address: 145 S. Pioneer Road Legal Entity Address: 2 Gannett Drive

City: Fon du Lac City: South Portland State: WI


Legal Entity Name: ANTHEM HEALTH PLANS OF NEW

HAMPSHIRE, INC. Contract Number: H7728 Organization Marketing Name: Anthem Blue Cross and Blue

Shield Parent Organization: Anthem Inc.






Legal Entity Address: 3000 Goffs Falls Road

City: Manchester State: NH

Zip: 031110001

Contact Title: Name: Customer Service Phone: 1-866-289-






Legal Entity Name: ANTHEM HEALTH PLANS OF

VIRGINIA, INC. Contract Number: H4909 Organization Marketing Name: Anthem Blue Cross and Blue





Address: 145 S. Pioneer Road Legal Entity Address: 2015 Staples Mill Road

City: Fon du Lac City: Richmond State: WI

State: VA Zip: 54935 Zip: 23230 Last Updated: 04/05/2013

Legal Entity Name: ANTHEM HEALTH PLANS, INC.

Contract Number: H2836 Organization Marketing Name: Anthem Blue Cross and Blue





Address: 145 S. Pioneer Road Legal Entity Address: 370 Bassett Road

City: Fon du Lac City: North Haven State: WI


Legal Entity Name: ANTHEM HEALTH PLANS, INC.

Contract Number: H5854 Organization Marketing Name: Anthem Blue Cross and Blue





Address: 145 S. Pioneer Road Legal Entity Address: 370 Bassett Road

City: Fon du Lac City: North Haven State: WI


Legal Entity Name: ANTHEM INSURANCE

COMPANIES, INC. Contract Number: H1517 Organization Marketing Name: Anthem Blue Cross and Blue








Legal Entity Address: 120 Monument Circle


Zip: 46204












Address: 145 S. Pioneer Road Legal Entity Address: 120 Monument Circle

City: Fon du Lac City: Indianapolis State: WI






















COMPANIES, INC. Contract Number: R5941 Organization Marketing Name: Anthem Blue Cross and Blue


Organization Type: Regional CCP Plan Type: Regional PPO



Legal Entity Address: 120 Monument Circle


Zip: 46204






Legal Entity Name: APPALACHIAN AGENCY FOR SENIOR

CITIZENS, INC. Contract Number: H2386 Organization Marketing Name: Appalachian Agency for Senior

Citizens, Inc, Parent Organization: Appalachian Agency for

Senior Citizens, Inc.

Organization Type: National PACE Contact Title: Program Director Plan Type: National PACE Name: Dana Collins



Address: P.O.B. 765 Legal Entity Address: P.O. Box 765

216 College Ridge Road City: Cedar Bluff City: Cedar Bluff State: VA


Legal Entity Name: ARCADIAN HEALTH PLAN, INC.

Contract Number: H5619 Organization Marketing Name: Arcadian Health Plan, Inc.

Parent Organization: Humana Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Pamela Wilson


CMS Region Responsible: Kansas City Fax: Enrollment: 7,428 Email: [email protected]

Address: 101 East Main Street Legal Entity Address: c/o Corporation Service Company, 300

Deschutes Way Suite 304 City: Louisville

City: Tumwater State: KY State: WA Zip: 40202

Zip: 98501 Last Updated: 05/07/2013 Legal Entity Name: ARIZONA PHYSICIANS IPA, INC. Contract

Number: H0321 Organization Marketing Name: UnitedHealthcare Community Plan

Parent Organization: UnitedHealth Group, Inc.

Organization Type: Local CCP Contact Title: Customer Service Plan Type: HMO/HMOPOS Name: Great Lakes Health Plan

Contract Effective Date: 09/01/2005 Phone: 1-888-903-7587


Tax Status: For Profit Extension: CMS Region Responsible: San Francisco Fax:

Enrollment: 36,889 Email: [email protected] Address: 26957 Northwestern Hwy

Legal Entity Address: 1 East Washington Suite 400 Suite 900 City: Southfield

City: Phoenix State: MI State: AZ Zip: 48033

Zip: 85004 Last Updated: 08/13/2014 Legal Entity Name: ARKANSAS SUPERIOR SELECT, INC.

Contract Number: H1587 Organization Marketing Name: Tribute Health Plan of Arkansas Parent

Organization: Select Founders, LLC

Organization Type: Local CCP Contact Title: Marketing & Education Director Plan Type: HMO/HMOPOS Name: Doug Shackelford



Address: 1401 West Capitol Ave, Suite 430 Legal Entity Address: 1401 West Capitol Ave, Suite 430

City: Little Rock City: Little Rock State: AR

State: AR Zip: 72201 Zip: 72201 Last Updated: 03/04/2015

Legal Entity Name: ASPIRE HEALTH PLAN Contract Number: H8764

Organization Marketing Name: Aspire Health Plan Parent Organization: Community Hospital Foundation

Organization Type: Local CCP Contact Title: Director, Client Services Plan Type: HMO/HMOPOS Name: Helen Stroub



Address: 4550 California Avenue Legal Entity Address: 23625 Holman Highway Suite 100 City:

Bakersfield City: Monterey State: CA


Legal Entity Name: ASURIS NORTHWEST HEALTH

Contract Number: H5010 Organization Marketing Name: Asuris Northwest Health

Parent Organization: Cambia Health Solutions, Inc.



CMS Region Responsible: Seattle Fax: Enrollment: 1,431 Email: [email protected] Address: PO

Box 12625 Legal Entity Address: 200 SW Market St

City: Salem City: Portland State: OR

State: OR Zip: 97309-0625 Zip: 97201 Last Updated: 03/03/2011


Legal Entity Name: ATLANTIS HEALTH PLAN, INC.

Contract Number: H9285 Organization Marketing Name: EASY CHOICE HEALTH PLAN

OF NEW YORK Parent Organization: America's 1st

Choice NY Holdings, LLC

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Michael Leon



Address: 80 Broad Street Legal Entity Address: 80 Broad Street, 5th Floor 5th Floor

City: New York City: New York State: NY


Legal Entity Name: ATRIO HEALTH PLANS Contract Number: H3814

Organization Marketing Name: ATRIO Health Plans Parent

Organization: ATRIO Health Plans



CMS Region Responsible: Seattle Enrollment: 2,131

Legal Entity Address: 2270 NW Aviation Drive

City: ROSEBURG State: OR

Zip: 97470

Contact Title: VP Clincal and Operations Name: Cynthia A

Swanson Phone: 1-971-209-4342 Extension:

Fax: 1-541-672-8670 Email: [email protected] Address: 2270 NW

Aviation Dr, Suite 3

City: Roseburg State: OR



Organization Marketing Name: ATRIO Health

Plans Parent Organization: ATRIO

Health Plans

Organization Type: Local CCP Contact Title: VP Clincal and Operations Plan Type: HMO/HMOPOS Name: Cynthia A Swanson



Address: 2270 NW Aviation Dr, Suite 3 Legal Entity Address: 2270 NW Aviation Drive, Suite 3

City: Roseburg City: Roseburg State: OR

State: OR Zip: 97470 Zip: 97470 Last Updated: 12/20/2013




Health Plans

Organization Type: Local CCP Contact Title: VP Clincal and Operations Plan Type: Local PPO Name: Cynthia A Swanson




Address: 2270 NW Aviation Dr, Suite 3 Legal Entity Address: 2270 NW Aviation Way






Health Plans

Organization Type: Local CCP Contact Title: VP Clincal and Operations Plan Type: Local PPO Name: Cynthia A Swanson



Address: 2270 NW Aviation Dr, Suite 3 Legal Entity Address: 2270 NW Aviation Drive, Suite 3



Legal Entity Name: AULTCARE HEALTH INSURING

CORPORATION Contract Number: H3664 Organization Marketing Name: PrimeTime Health Plan

Parent Organization: Aultman Health Foundation




Legal Entity Address: 214 DARTMOUTH AVENUE SW

City: CANTON State: OH

Zip: 44710

Contact Title: Customer Service Supervisor

Name: Lisa Bowling-Shaffer Phone: 1-330-363-7407


Address: 214 Dartmouth Ave SW

City: Canton State: OH


Legal Entity Name: AVMED, INC. Contract Number: H1016

Organization Marketing Name: AvMed Medicare Parent

Organization: AvMed, Inc.

Organization Type: Local CCP Contact Title: Manager, Medicare Compliance Plan Type: HMO/HMOPOS Name: Jacqueline M Crews


CMS Region Responsible: Atlanta Fax: 1-352-337-8551 Enrollment: 30,851 Email: [email protected] Address: AvMed, Inc.

Legal Entity Address: 4300 N.W. 89TH BLVD. 4300 NW 89 Blvd. City: Gainesville

City: GAINESVILLE State: FL State: FL Zip: 32606



Legal Entity Name: BCBS OF MASSACHUSETTS HMO

BLUE, INC. Contract Number: H2230 Organization Marketing Name: Blue Cross Blue Shield of

Massachusetts Parent Organization: Blue Cross and Blue Shield of

Massachusetts, Inc.

Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Member Services


CMS Region Responsible: Boston Fax: Enrollment: 29,739 Email: [email protected]

Address: 25 Technology Place Legal Entity Address: 101 Huntington Ave Mailstop 03-02

Suite 1300 City: Hingham City: BOSTON State: MA

State: MA Zip: 02043-4359 Zip: 021997611 Last Updated: 06/10/2010

Legal Entity Name: BCBS OF MASSACHUSETTS HMO

BLUE, INC. Contract Number: H2261 Organization Marketing Name: Blue Cross Blue Shield of

Massachusetts Parent Organization: Blue Cross and Blue Shield of

Massachusetts, Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Member Services



Address: 25 Technology Place Legal Entity Address: 101 Huntington Ave Mailstop 03-02

Suite 1300 City: Hingham City: BOSTON State: MA

State: MA Zip: 02043-4359 Zip: 021997611 Last Updated: 06/10/2010

Legal Entity Name: BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY Contract Number: H9572 Organization Marketing Name: Blue Cross Blue Shield of Michigan Parent Organization: Blue

Cross Blue Shield of Michigan

Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Corey Taliaferro

Contract Effective Date: 01/01/2010 Phone: 1-866-309-1719 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Chicago Fax: Enrollment: 331,702 Email: [email protected]

Address: 600 East Lafayette Blvd. Legal Entity Address: 600 East Lafayette Blvd. 0333

City: Detroit City: Detroit State: MI State: MI Zip: 48226 Zip: 48226 Last Updated: 11/13/2013

Legal Entity Name: BEACON HEALTH AND SOCIAL

SERVICES, INC. Contract Number: H9323 Organization Marketing Name: Beacon of LIFE

Parent Organization: Beacon Health & Social Service, Inc.

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Sue Skola



Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: New York Fax: 1-732-806-3319

Enrollment: * Email: [email protected]

Address: 1075 Stephenson Avenue Legal Entity Address: 1075 Stephenson Avenue

City: Oceanport City: Ocean Port State: NJ


Legal Entity Name: BEHEALTHY FLORIDA, INC. Contract

Number: H2758 Organization Marketing Name: BlueMedicare Preferred HMO

Parent Organization: Guidewell Mutual Holding Corporation

Organization Type: Local CCP Contact Title: Compliance Officer Plan Type: HMO/HMOPOS Name: Sylvia L Freeman


CMS Region Responsible: Atlanta Fax: Enrollment: 828 Email: [email protected] Address:

6948 Professional Parkway East Legal Entity Address: 6948 Professional Parkway East

City: Sarasota City: Sarasota State: FL


Legal Entity Name: BIENVIVIR SENIOR HEALTH

SERVICES Contract Number: H4518 Organization Marketing Name: Bienvivir Senior Health Services

Parent Organization: Bienvivir Senior Health Services

Organization Type: National PACE Contact Title: Senior VP of Finance Plan Type: National PACE Name: Joaquin Garcia


CMS Region Responsible: Dallas Fax: Enrollment: 832 Email: [email protected]

Address: 2300 Mckinley Legal Entity Address: 2300 McKinley

City: El Paso City: EL PASO State: TX


Legal Entity Name: BLUE CARE NETWORK OF

MICHIGAN Contract Number: H5883 Organization Marketing Name: Blue Care Network

Parent Organization: Blue Cross Blue Shield of Michigan




Legal Entity Address: 20500 Civic Center Drive

City: Southfield State: MI

Zip: 48076

Contact Title: Manager, Provider Affairs Name: Betty Jo Byers Phone: 1-800-255-1690


Address: 4520 Linden Creek Parkway B258

City: Flint State: MI



Legal Entity Name: BLUE CROSS & BLUE SHIELD OF

RHODE ISLAND Contract Number: H4152 Organization Marketing Name: Blue Cross & Blue Shield of Rhode

Island Parent Organization: Blue Cross & Blue Shield of

Rhode Island

Organization Type: Local CCP Contact Title: Customer Service Department Plan Type: HMO/HMOPOS Name: Customer Service Department



Address: 500 Exchange Street Legal Entity Address: 500 Exchange St.

City: Providence City: PROVIDENCE State: RI

State: RI Zip: 02903 Zip: 029032699 Last Updated: 04/17/2014

Legal Entity Name: BLUE CROSS AND BLUE SHIELD OF

ALABAMA Contract Number: H0104 Organization Marketing Name: Blue Advantage (PPO)

Parent Organization: BlueCross BlueShield of Alabama

Organization Type: Local CCP Contact Title: Manager Claims Operations Plan Type: Local PPO Name: Jeff Corley



Address: 450 Riverchase Parkway East Legal Entity Address: 450 RIVERCHASE PARKWAY EAST

City: Birmingham City: BIRMINGHAM State: AL

State: AL Zip: 35244 Zip: 35244 Last Updated: 09/10/2013


FLORIDA, INC. Contract Number: H5434 Organization Marketing Name: Florida Blue


Organization Type: Local CCP Contact Title: Senior Director Gvn Programs & Product Compliance Plan Type: Local PPO Name: Brendan Hodges



Address: 4800 Deerwood Campus Parkway Legal Entity Address: 4800 DEERWOOD CAMPUS PARKWAY DCC Building 100, 7th Floor

City: Jacksonville City: JACKSONVILLE State: FL



FLORIDA, INC. Contract Number: R3332 Organization Marketing Name: Florida Blue


Organization Type: Regional CCP Contact Title: Senior Director Gvn Programs & Product Compliance Plan Type: Regional PPO Name: Brendan Hodges





Address: 4800 Deerwood Campus Parkway Legal Entity Address: 4800 Deerwood Campus Parkway DCC Building 100, 7th Floor

Bldg. 100 / 8th Floor City: Jacksonville City: Jacksonville State: FL



GEORGIA, INC. Contract Number: H9947 Organization Marketing Name: Blue Cross Blue Shield of

Georgia Parent Organization: Anthem Inc.




Address: 145 S. Pioneer Road Legal Entity Address: 3350 Peachtree Road NE

City: Fon du Lac City: Atlanta State: WI



MINNESOTA Contract Number: H2461 Organization Marketing Name: Blue Cross and Blue Shield of

Minnesota Parent Organization: Blue Cross and Blue Shield

of Minnesota

Organization Type: 1876 Cost Contact Title: Plan Type: 1876 Cost Name: Customer Service



Address: 3400 Yankee Drive Legal Entity Address: 3400 Yankee Drive

City: Eagan City: Eagan State: MN

State: MN Zip: 55121-1627 Zip: 55122 Last Updated: 09/11/2006

Legal Entity Name: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA Contract

Number: H3404 Organization Marketing Name: Blue Cross and Blue Shield of North Carolina Parent

Organization: Blue Cross and Blue Shield of North Carolina Organization Type: Local CCP Contact Title: Call Center support Plan Type: Local PPO Name: Member Services

Contract Effective Date: 07/01/2005 Phone: 1-888-296-9790 Tax Status: Not-for-Profit/Non-Profit

Extension: CMS Region Responsible: Atlanta Fax: Enrollment: 51,453 Email: [email protected]

Address: Blue Cross and Blue Shield of North Carolina Legal Entity Address: P.O Box 2291 5660 University Pkwy

City: Winston Salem City: Durham State: NC State: NC Zip: 27105 Zip: 277022291 Last Updated: 05/29/2014


Legal Entity Name: BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA Contract

Number: H3449 Organization Marketing Name: Blue Cross and Blue Shield of North Carolina Parent

Organization: Blue Cross and Blue Shield of North Carolina Organization Type: Local CCP Contact Title: Call Center support Plan Type: HMO/HMOPOS Name: Member Services


Extension: CMS Region Responsible: Atlanta Fax: Enrollment: 75,567 Email: [email protected]

Address: Blue Cross and Blue Shield of North Carolina Legal Entity Address: P.O. Box 2291 5660 University Pkwy

City: Winston Salem City: Durham State: NC State: NC Zip: 27105 Zip: 277022291 Last Updated: 05/29/2014

Legal Entity Name: BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA Contract Number:

H5422 Organization Marketing Name: Blue Cross Blue Shield Healthcare Plan of Georgia Parent

Organization: Anthem Inc. Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Customer Service


Address: 145 S. Pioneer Road Legal Entity Address: 3350 Peachtree Road NE

City: Fon du Lac City: Atlanta State: WI State: GA Zip: 54935 Zip: 30326 Last Updated: 04/05/2013

Legal Entity Name: BLUE CROSS OF CALIFORNIA

Contract Number: H0564 Organization Marketing Name: Anthem Blue Cross Parent





Address: 145 S. Pioneer Road Legal Entity Address: 21555 Oxnard Street

City: Fon du Lac City: Woodland Hills State: WI


Legal Entity Name: BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC. Contract Number:

H6229 Organization Marketing Name: Anthem Blue Cross Cal MediConnect Parent



Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Customer Service

Contract Effective Date: 07/01/2014 Phone: 1-866-289-4250 Tax Status: For Profit Extension: CMS Region Responsible: San Francisco Fax: Enrollment: 8,475 Email: [email protected]

Address: 145 S. Pioneer Road Legal Entity Address:

120 S. Via Merida Building 2 City: Fon du Lac City: Thousand Oaks State: WI State: CA Zip: 54935 Zip: 91362 Last Updated: 04/05/2013

Legal Entity Name: BLUE CROSS OF IDAHO CARE

PLUS, INC. Contract Number: H1302 Organization Marketing Name: Blue Cross of Idaho

Parent Organization: Blue Cross of Idaho Health

Services, Inc.


CCP Plan Type: Local

PPO Contract Effective Date: 07/01/2005

Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: Seattle

Enrollment: 10,591

Legal Entity Address: 3000 E Pine Ave

City: MERIDIAN State: ID

Zip: 83642

Contact Title: Mgr Customer Advocates Name: Sheri Core Phone: 1-888-494-2583


Email: [email protected]

Address: 3000 E. Pine Ave.

City: Meridian State: ID


Legal Entity Name: BLUE CROSS OF IDAHO CARE PLUS, INC.

Contract Number: H1350 Organization Marketing Name: Blue Cross of Idaho

Parent Organization: Blue Cross of Idaho Health Services, Inc.

Organization Type: Local CCP Contact Title: Mgr Customer Advocates Plan Type: HMO/HMOPOS Name: Sheri Core


CMS Region Responsible: Seattle Fax: 1-208-387-6811 Enrollment: 22,716 Email: [email protected] Address:

3000 E. Pine Ave. Legal Entity Address: 3000 E. PINE AVE.

City: Meridian City: MERIDIAN State: ID

State: ID Zip: 83642 Zip: 83642 Last Updated: 01/07/2011

Legal Entity Name: BLUE PLUS Contract Number: H2425

Organization Marketing Name: Blue Plus Parent Organization: Blue Cross and Blue Shield of Minnesota




Address: 3400 Yankee Drive


Legal Entity Address: 3400 Yankee Drive City: Eagan

City: Eagan State: MN State: MN Zip: 55121

Zip: 551211627 Last Updated: 10/04/2006 Legal Entity Name: BLUECROSS BLUESHIELD OF

TENNESSEE, INC. Contract Number: H7917 Organization Marketing Name: BlueCross BlueShield of

Tennessee Parent Organization: BlueCross BlueShield of

Tennessee

Organization Type: Local CCP Contact Title: Dir Product Strategy & Finance Plan Type: Local PPO Name: Paul Farrell



Address: 1 Cameron Hill Circle Legal Entity Address: 1 Cameron Hill Circle

City: Chattanooga City: Chattanooga State: TN


Legal Entity Name: BRAVO HEALTH MID-ATLANTIC, INC.

Contract Number: H2108 Organization Marketing Name: Cigna-HealthSpring Parent

Organization: CIGNA




Legal Entity Address: 3601 O'Donnell Street

City: BALTIMORE State: MD

Zip: 21224

Contact Title: Name: Wendy Wetzel Phone: 1-800-668-3813

Extension: Fax: Email: [email protected] Address: PO

Box 20002



Legal Entity Name: BRAVO HEALTH PENNSYLVANIA,

INC. Contract Number: H3949 Organization Marketing Name: Cigna-HealthSpring

Parent Organization: CIGNA

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Wendy Wetzel


CMS Region Responsible: Dallas Fax: Enrollment: 55,263 Email: [email protected]

Address: PO Box 20002 Legal Entity Address: 1500 Spring Garden Street, Suite

800 City: Nashville City: PHILADELPHIA State: TN


Legal Entity Name: BRIDGEWAY HEALTH

SOLUTIONS Contract Number: H5590 Organization Marketing Name: Bridgeway Health Solutions




Plan Type: HMO/HMOPOS Name: Member Services Contract Effective Date: 01/01/2008 Phone: 1-877-935-8020

Tax Status: For Profit Extension: CMS Region Responsible: Seattle Fax:


Address: 1501 W. Fountainhead Pwy Legal Entity Address: 1501 West Fountainhead Parkway,

#295 Suite 295 City:

Tempe City: Tempe State: AZ

State: AZ Zip: 85282 Zip: 85282 Last Updated: 03/04/2015

Legal Entity Name: BUCKEYE COMMUNITY HEALTH

PLAN, INC. Contract Number: H0022 Organization Marketing Name: Buckeye Health Plan -

MyCare Ohio Parent Organization: Centene

Corporation





Address: 175 South Third Street, Suite 1200 Legal Entity Address: 4349 Easton Way, Suite 400 Suite 1200

City: Columbus City: Columbus State: OH


Legal Entity Name: BUCKEYE COMMUNITY HEALTH

PLAN, INC. Contract Number: H0908 Organization Marketing Name: Buckeye Health Plan




CMS Region Responsible: Seattle Enrollment: 999

Legal Entity Address: 4349 Easton Way, Suite 400

City: Columbus State: OH

Zip: 43219

Contact Title: Name: Member Services Phone: 1-866-389-


Address: 175 South Third Street, Suite 1200 Suite 1200



Legal Entity Name: C AND O EMPLOYEES' HOSPITAL

ASSOCIATION Contract Number: H4906 Organization Marketing Name: C and O Employees' Hospital Association

Parent Organization: C & O Employees' Hospital Association

Organization Type: HCPP - 1833 Cost Contact Title: Medicare Dues Clerk Plan Type: HCPP - 1833 Cost Name: Rodney Nicely


CMS Region Responsible: Philadelphia Fax: 1-540-862-4958 Enrollment: 2,245 Email: [email protected]

Address: 511 Main Street, 2nd Floor Legal Entity Address: 511 MAIN STREET, 2ND FLOOR

City: Clifton Forge City: CLIFTON FORGE State: VA



Legal Entity Name: CALIFORNIA PHYSICIANS' SERVICE

Contract Number: H0504 Organization Marketing Name: Blue Shield of California

Parent Organization: California Physicians' Service




Address: 6300 Canoga Avenue Legal Entity Address: 6300 CANOGA AVENUE

City: Woodland Hills City: WOODLAND HILLS State: CA


Legal Entity Name: CAPITAL ADVANTAGE INSURANCE

COMPANY Contract Number: H3923 Organization Marketing Name: Capital Advantage Insurance

Company Parent Organization: Capital BlueCross

Organization Type: Local CCP Contact Title: Customer Service Manager Plan Type: Local PPO Name: Barbara Keffer



Address: 2500 Elmerton Avenue Legal Entity Address: 2500 ELMERTON AVENUE P.O. Box 774135 City:

Harrisburg City: HARRISBURG State: PA

State: PA Zip: 17177-4135 Zip: 17177 Last Updated: 03/07/2014

Legal Entity Name: CAPITAL DISTRICT PHYSICIANS'

HEALTH PLAN, INC. Contract Number: H3388 Organization Marketing Name: CDPHP Medicare Choices

Parent Organization: Capital District Physicians' Health Plan,

Inc.




Legal Entity Address: 500 Patroon Creek Blvd

City: ALBANY

State: NY Zip: 12206

Contact Title: Director, Medicare Operations and

Compliance Name: Elizabeth Loomis Phone: 1-800-926-7526

Extension: Fax:

Email: [email protected] Address: 500 Patroon Creek Blvd

City: Albany State: NY


Legal Entity Name: CAPITAL HEALTH PLAN Contract Number: H5938

Organization Marketing Name: Capital Health Plan Parent Organization: Guidewell Mutual Holding

Corporation

Organization Type: Local CCP Contact Title: Network Services Supervisor Plan Type: HMO/HMOPOS Name: Beth Maige



CMS Region Responsible: Atlanta Fax: 1-850-383-3413 Enrollment: 17,529 Email: [email protected]

Address: P.O. Box 15349 Legal Entity Address: 2140 CENTERVILLE

PLACE City: Tallahassee City: TALLAHASSEE State: FL


Legal Entity Name: CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY Contract Number:

R6801 Organization Marketing Name: Care Improvement Plus

Parent Organization: UnitedHealth Group, Inc. Organization Type: Regional CCP Contact Title: Plan Type: Regional PPO Name: Customer Service


Address: P.O. Box 29675 Legal Entity Address: 351 West Camden Street

Suite 100 City: Hot Springs City: Baltimore State: AR State: MD Zip: 71903 Zip: 21201 Last Updated: 04/24/2014

Legal Entity Name: CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. Contract

Number: H5322 Organization Marketing Name: UnitedHealthcare

Parent Organization: UnitedHealth Group, Inc. Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Customer Service


Address: P.O. Box 29675 Legal Entity Address: 351 W. Camden Street


Legal Entity Name: CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. Contract Number:

H6528 Organization Marketing Name: Care Improvement Plus

Parent Organization: UnitedHealth Group, Inc. Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Customer Service





Legal Entity Name: CARE IMPROVEMENT PLUS SOUTH CENTRAL

INSURANCE CO. Contract Number: R3444 Organization Marketing Name: Care Improvement Plus


Contract Effective Date: 01/01/2007 Phone: 1-877-842-3210 Tax Status: For Profit

Extension: CMS Region Responsible: San Francisco Fax: Enrollment: 59,045 Email: [email protected]



Legal Entity Name: CARE IMPROVEMENT PLUS SOUTH CENTRAL

INSURANCE CO. Contract Number: R9896 Organization Marketing Name: Care Improvement Plus






Legal Entity Name: CARE IMPROVEMENT PLUS WISCONSIN INSURANCE

COMPANY Contract Number: H0294 Organization Marketing Name: Care Improvement Plus






Legal Entity Name: CARE IMPROVEMENT PLUS WISCONSIN INSURANCE

COMPANY Contract Number: H3794 Organization Marketing Name: UnitedHealthcare





Extension: CMS Region Responsible: San Francisco Fax: Enrollment: 76 Email: [email protected]

Address: P.O. Box 29675 Legal Entity Address: 351 W. Camden Street


Legal Entity Name: CARE N' CARE INSURANCE COMPANY,

INC. Contract Number: H2171 Organization Marketing Name: Care N' Care Insurance Company

Parent Organization: North Texas Specialty Physicians

Organization Type: Local CCP Contact Title: Director, Compliance & Government Programs Plan Type: HMO/HMOPOS Name: Nakia Smith



Address: 1701 River Run Legal Entity Address: 1701 River Run Suite 402

Suite 402 City: Fort Worth City: Fort Worth State: TX


Legal Entity Name: CARE N' CARE INSURANCE COMPANY,

INC. Contract Number: H6328 Organization Marketing Name: Care NÆ Care Insurance Company

Parent Organization: North Texas Specialty Physicians

Organization Type: Local CCP Contact Title: Director, Compliance & Government Programs Plan Type: Local PPO Name: Nakia Smith


CMS Region Responsible: Dallas Fax: 1-817-529-5265 Enrollment: 10,100 Email: [email protected]

Address: 1701 River Run Legal Entity Address: 1701 River Run Suite 402

Suite 402 City: Fort Worth City: Fort Worth State: TX


Legal Entity Name: CARE RESOURCES Contract Number: H5610

Organization Marketing Name: Care

Resources Parent Organization: Care

Resources

Organization Type: National PACE Contact Title: Director of Claims Plan Type: National PACE Name: Becky Haggerty



Address: 1471 Grace Street SE Legal Entity Address: 1471 Grace Street SE

City: Grand Rapids


City: Grand Rapids State: MI State: MI Zip: 49506

Zip: 49506 Last Updated: 02/04/2015 Legal Entity Name: CARE WISCONSIN HEALTH PLAN, INC.

Contract Number: H5209 Organization Marketing Name: Care Wisconsin Health Plan, Inc.

Parent Organization: Care Wisconsin First, Inc.



CMS Region Responsible: Chicago Enrollment: 995

Legal Entity Address: 1617 Sherman Avenue PO BOX 14017

City: MADISON State: WI

Zip: 537080017



Address: P.O. Box 14017

City: Madison State: WI

Zip: 53708-0017 Last Updated: 05/18/2015

Legal Entity Name: CARE1ST HEALTH PLAN Contract Number: H0148

Organization Marketing Name: Care1st Health Plan

Parent Organization: Care1st Health Plan

Organization Type: Demo Contact Title: V.P., Program Development Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Jamie Ueoka


CMS Region Responsible: San Francisco Fax: Enrollment: 9,340 Email: [email protected] Address:

601 Potrero Grande Drive Legal Entity Address: 601 Potrero Grande Drive

City: Monterey Park City: Monterey Park State: CA


Legal Entity Name: CARE1ST HEALTH PLAN Contract Number: H5928

Organization Marketing Name: Care1st Health Plan Parent

Organization: Care1st Health Plan

Organization Type: Local CCP Contact Title: VP of Product Line Development Plan Type: HMO/HMOPOS Name: Jamie Ueoka


CMS Region Responsible: San Francisco Fax: Enrollment: 54,794 Email: [email protected] Address: 601

Potrero Grande Drive Legal Entity Address: 601 Potrero Grande

City: Monterey Park City: Monterey Park State: CA


Legal Entity Name: CAREMORE HEALTH PLAN

Contract Number: H0544 Organization Marketing Name: CareMore Health Plan Parent


Organization Type: Local CCP Contact Title: Manager of Membership & Eligibility Dept. Plan Type: HMO/HMOPOS Name: Lisa Sarinana




Address: 12900 Park Plaza Drive Legal Entity Address: 12900 Park Plaza Drive Suite 150

SUITE 150 City: Cerritos City: CERRITOS State: CA


Legal Entity Name: CAREMORE HEALTH PLAN OF

ARIZONA, INC. Contract Number: H2593 Organization Marketing Name: CareMore Health Plan of Arizona,

Inc. Parent Organization: Anthem Inc.




Address: 12900 Park Plaza Drive Legal Entity Address: 12900 Park Plaza Drive, Suite 150 Suite 150

City: Cerritos City: Cerritos State: CA


Legal Entity Name: CAREMORE HEALTH PLAN OF

NEVADA Contract Number: H4346 Organization Marketing Name: CareMore Health Plan of

Nevada Parent Organization: Anthem Inc.




Address: 12900 Park Plaza Drive Legal Entity Address: 12900 Park Plaza Drive, Suite

150 Suite 150

City: Cerritos City: Cerritos State: CA


Legal Entity Name: CAREPLUS HEALTH PLANS,

INC. Contract Number: H1019 Organization Marketing Name: CarePlus Health Plans, Inc.





Address: 101 East Main Street Legal Entity Address: 11430 NW 20th Street

Suite 300 City: Louisville City: Miami State: KY



Legal Entity Name: CAREPOINT INSURANCE

COMPANY Contract Number: H5141 Organization Marketing Name: CLOVER HEALTH

Parent Organization: IJKG Opco LLC

Organization Type: Local CCP Contact Title: Manager, Regulatory and Compliance Plan Type: Local PPO Name: Travis Sutphin


CMS Region Responsible: New York Fax: 1-732-384-2282 Enrollment: 7,274 Email: [email protected]

Address: Harborside Financial Center Legal Entity Address: Harborside Financial Center Plaza 10 Suite 803

Plaza Ten, Suite 803 City: Jersey City City: Jersey City State: NJ


Legal Entity Name: CARESOURCE Contract Number: H8452

Organization Marketing Name: CareSource MyCare Ohio Parent Organization: CareSource Management

Group Co.

Organization Type: Demo Contact Title: Director, Marketing Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Tim Cloonan



Address: P. O. Box 8738 Legal Entity Address: 230 N. Main Street

City: Dayton City: Dayton State: OH


Legal Entity Name: CARITEN HEALTH PLAN INC.

Contract Number: H4461 Organization Marketing Name: Cariten Health Plan Inc.





Address: 101 East Main Street Legal Entity Address: 2160 Lakeside Centre Way, Suite

200 City: Louisville City: Knoxville State: KY


Legal Entity Name: CAROLINA SENIORCARE Contract

Number: H1357 Organization Marketing Name: Carolina SeniorCare

Parent Organization: United Church Homes and Services

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Thomas Chang


CMS Region Responsible: Atlanta Fax: 1-336-746-3519


Enrollment: 144 Email: [email protected] Address: 802

East Center Street Legal Entity Address: 802 East Center Street

City: Lexington City: Lexington State: NC

State: NC Zip: 27292 Zip: 27292 Last Updated: 12/18/2013

Legal Entity Name: CATHOLIC HEALTH SYSTEM

BUFFALO PACE Contract Number: H1518 Organization Marketing Name: Catholic Health LIFE

Parent Organization: Catholic Health System, Inc.

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: John Beyer



Address: 55 Melroy Avenue Legal Entity Address: 55 Melroy Avenue

City: Lackawanna City: Lackawanna State: NY


Legal Entity Name: CATHOLIC MANAGED LONG TERM

CARE, INC. Contract Number: H4393 Organization Marketing Name: ArchCare Senior Life

Parent Organization: Catholic Health Care System

Organization Type: National PACE Plan Type: National PACE



Legal Entity Address: 1432 Fifth Avenue

City: New York State: NY

Zip:

10035

Contact Title: Director of Quality Assurance Name: Janet O'Connor Phone: 1-646-289-


Address: 1432 Fifth Avenue



Legal Entity Name: CATHOLIC SPECIAL NEEDS

PLAN, LLC Contract Number: H1777 Organization Marketing Name: ArchCare Advantage

Parent Organization: Catholic Health Care System

Organization Type: Local CCP Contact Title: Director of Regulatory Compliance Plan Type: HMO/HMOPOS Name: Victor Fama



Address: 33 Irving Place Legal Entity Address: 205 Lexington Avenue 11th Floor

14th Floor City: New York City: New York State: NY



Legal Entity Name: CDPHP UNIVERSAL BENEFITS,

INC. Contract Number: H5042 Organization Marketing Name: CDPHP Medicare Choices

Parent Organization: Capital District Physicians'

Health Plan, Inc.

Organization Type: Local CCP Contact Title: Director, Medicare Operations and

Compliance Plan Type: Local PPO Name: Elizabeth Loomis



Address: 500 Patroon Creek

Blvd Legal Entity Address: 500 Patroon Creek Blvd.

City: Albany City: Albany State: NY


Legal Entity Name: CENTER FOR ELDERS

INDEPENDENCE Contract Number: H5405 Organization Marketing Name: Center For Elders'

Independence Parent Organization: Center For Elders Independence

Organization Type: National PACE Contact Title: IT Manager Plan Type: National PACE Name: Mohammed Moharram


CMS Region Responsible: San Francisco Fax: Enrollment: 603 Email: [email protected]

Address: 510-17th St., Suite 400 Legal Entity Address: 510-17th St., Suite 400

City: Oakland City: OAKLAND State: CA


Legal Entity Name: CENTER FOR SENIOR

INDEPENDENCE Contract Number: H2318 Organization Marketing Name: PACE Southeast

Michigan Parent Organization: Henry Ford

Health System

Organization Type: National PACE Contact Title: President & CEO Plan Type: National PACE Name: Mary Naber



Address: 7800 W Outer Drive Legal Entity Address: 7800 W. OUTER DRIVE, SUITE

240 Suite 240

City: Detroit City: DETROIT State: MI


Legal Entity Name: CENTERLIGHT HEALTHCARE,

INC. Contract Number: H3329 Organization Marketing Name: CenterLight Healthcare

Parent Organization: CenterLight Health System, Inc.


Organization Type: National PACE Contact Title: VP for Provider Relations & Network

Development Plan Type: National PACE Name: Cathy Neiman



Address: 1250 Waters Place Legal Entity Address: 1250 Waters Place Tower 1, Suite 602

Tower 1, Suite 602 City: Bronx City: BRONX State: NY



INC. Contract Number: H5989 Organization Marketing Name: CenterLight Healthcare

Parent Organization: CenterLight Health System, Inc.

Organization Type: Local CCP Contact Title: VP for Provider Relations & Network

Development Plan Type: HMO/HMOPOS Name: Cathy Neiman




Tower 1, Suite 602 City: Bronx City: Bronx State: NY



INC. Contract Number: H8420 Organization Marketing Name: CenterLight Healthcare FIDA

Plan Parent Organization: CenterLight Health System,

Inc.

Organization Type: Demo Contact Title: VP for Provider Relations & Network

Development Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Cathy Neiman




Tower 1, Suite 602 City: Bronx City: Bronx State: NY


Legal Entity Name: CENTERS PLAN FOR HEALTHY

LIVING, LLC Contract Number: H3018 Organization Marketing Name: Centers Plan for FIDA Care

Complete Parent Organization: Centers Plan for Healthy Living,

LLC

Organization Type: Demo Contact Title: DIrector of Regulatory Compliance Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Salamon Reyes


CMS Region Responsible: New York Fax:


Enrollment: 65 Email: [email protected] Address: 75 Vanderbilt avenue

Legal Entity Address: 75 Vanderbilt Avenue suite 600 Suite 600 City: Staten Island

City: Staten Island State: NY State: NY Zip: 10304


Legal Entity Name: CENTERS PLAN FOR HEALTHY LIVING,

LLC Contract Number: H6988 Organization Marketing Name: Centers Plan for Healthy Living

Parent Organization: Centers Plan for Healthy Living, LLC

Organization Type: Local CCP Contact Title: DIrector of Regulatory Compliance Plan Type: HMO/HMOPOS Name: Salamon Reyes



Address: 75 Vanderbilt avenue Legal Entity Address: 75 Vanderbilt Ave. suite 600

Suite 600 City: Staten Island City: Staten Island State: NY


Legal Entity Name: CENTRA HEALTH, INC. Contract Number: H8096

Organization Marketing Name: Centra PACE Parent Organization: Centra Health, Inc.

Organization Type: National PACE Contact Title: Centra PACE Program Director Plan Type: National PACE Name: George C Graham


CMS Region Responsible: Philadelphia Fax: Enrollment: 165 Email: [email protected]

Address: 407 Federal Street Legal Entity Address: 407 Federal Street

City: Lynchburg City: Lynchburg State: VA


Legal Entity Name: CENTRAL HEALTH PLAN OF CALIFORNIA,

INC. Contract Number: H5649 Organization Marketing Name: Central Health Medicare Plan

Parent Organization: AHMC Central Health LLC

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Marketing Department



Address: 1540 Bridgegate Drive Legal Entity Address: 1540 Bridgegate Drive

City: Diamond Bar City: Diamond Bar State: CA


Legal Entity Name: CENTRAL VALLEY MEDICAL SERVICES CORPORATION Contract Number: H9592 Organization Marketing Name: Fresno PACE

Parent Organization: Central Valley Medical Services Corporation


Organization Type: National PACE Contact Title: Administrator Plan Type: National PACE Name: Abe Marouf

Contract Effective Date: 08/01/2014 Phone: 1-559-400-6422 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: San Francisco Fax: 1-877-641-0513 Enrollment: 94 Email: [email protected]

Address: 2042 Kern St. Legal Entity Address: 2042 Kern St. City: Fresno

City: Fresno State: CA State: CA Zip: 93721 Zip: 93721 Last Updated: 09/02/2014

Legal Entity Name: CHA HMO, INC. Contract Number: H0028

Organization Marketing Name: CHA HMO, Inc. Parent Organization: Humana Inc.




Address: 101 East Main Street Legal Entity Address: 500 West Main Street

City: Louisville City: Louisville State: KY

State: KY Zip: 40202 Zip: 40202 Last Updated: 05/07/2013

Legal Entity Name: CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC. Contract Number: H3473 Organization Marketing Name: Blue Ridge PACE

Parent Organization: Riverside Healthcare Association

Organization Type: National PACE Contact Title: Business Manager Plan Type: National PACE Name: Courtney Berg Contract Effective Date: 03/01/2014 Phone: 1-757-234-8433 Tax Status: Not-for-Profit/Non-Profit Extension:


Address: 439 Oriana Road Suite B Legal Entity Address: 439 Oriana Road Suite B

City: Newport News City: Newport News State: VA State: VA Zip: 23608 Zip: 23608 Last Updated: 12/16/2013

Legal Entity Name: CHEROKEE NATION COMPREHENSIVE CARE AGENCY Contract Number: H4142 Organization Marketing Name: Cherokee Elder Care

Parent Organization: Cherokee Nation Comprehensive Care Agency


Organization Type: National PACE Contact Title: Chief Financial Officer Plan Type: National PACE Name: Thelma Pittman-Alderson

Contract Effective Date: 08/01/2008 Phone: 1-918-207-4936 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Dallas Fax: 1-918-431-4112 Enrollment: 140 Email: [email protected]

Address: 1387 W 4th St. Legal Entity Address: 1387 W 4th St.

City: Tahlequah City: Tahlequah State: OK State: OK Zip: 74464 Zip: 74464 Last Updated: 05/12/2014

Legal Entity Name: CHINESE COMMUNITY HEALTH PLAN

Contract Number: H0571 Organization Marketing Name: Chinese Community Health Plan

Parent Organization: Chinese Hospital Association



CMS Region Responsible: San Francisco Enrollment: 8,373

Legal Entity Address: 445 Grant Avenue Suite 700

City: SAN FRANCISCO State: CA Zip: 94108

Contact Title: Manager of Marketing Name:

YoungSoo Cho Phone: 1-415-955-8800 Extension: 3309


Address: 445 Grant Avenue Suite 700

City: San Francisco State: CA


Legal Entity Name: CHRISTUS HEALTH PLAN Contract

Number: H1189 Organization Marketing Name: CHRISTUS Health Plan Generations

Parent Organization: CHRISTUS Health Plan

Organization Type: Local CCP Contact Title: Executive Director Plan Type: HMO/HMOPOS Name: Anita Leal



Address: 919 Hidden Ridge Legal Entity Address: 919 Hidden Ridge

City: Irving City: Irving State: TX


Legal Entity Name: CIGNA HEALTH AND LIFE INSURANCE

COMPANY Contract Number: H3945 Organization Marketing Name: Cigna-

HealthSpring Parent Organization:

CIGNA




Address: PO Box 20002 Legal Entity Address: 900 Cottage Grove Rd

City: Nashville


City: Bloomfield State: TN State: CT Zip: 37202

Zip: 06002 Last Updated: 02/06/2015 Legal Entity Name: CIGNA HEALTHCARE OF ARIZONA,

INC. Contract Number: H0354 Organization Marketing Name: Cigna


Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Heather Dunn



Address: PO Box 42005 Legal Entity Address: 25500 N. Norterra Drive

Bldg B-Cigna Medicare Services City: Phenix City: PHOENIX State: AZ

State: AZ Zip: 85080-2005 Zip: 85085 Last Updated: 02/06/2015

Legal Entity Name: CIGNA HEALTHCARE OF GEORGIA,

INC. Contract Number: H0439 Organization Marketing Name: Cigna-HealthSpring





Address: PO Box 20002 Legal Entity Address: Two Securities Center

3500 Piedmont Rd, Suite 2 City: Nashville City: Atlanta State: TN


Legal Entity Name: CIGNA HEALTHCARE OF NORTH

CAROLINA, INC. Contract Number: H9725 Organization Marketing Name: Cigna-

Healthspring Parent Organization:

CIGNA




Address: PO Box 20002 Legal Entity Address: 701 Corporate Center Dr

City: Nashville City: Raleigh State: TN


Legal Entity Name: CIGNA HEALTHCARE OF SOUTH

CAROLINA, INC. Contract Number: H7020 Organization Marketing Name: Cigna-

Healthspring Parent Organization:

CIGNA



Plan Type: HMO/HMOPOS Name: Wendy Wetzel Contract Effective Date: 01/01/2014 Phone: 1-800-668-3813

Tax Status: For Profit Extension: CMS Region Responsible: Dallas Fax:


Address: PO Box 20002 Legal Entity Address: 4000 Faber Place Dr.

Suite 220 City: Nashville City: Charleston State: TN


Legal Entity Name: CLEARRIVER HEALTH Contract Number: H7903

Organization Marketing Name: ClearRiver Health Parent Organization: Catholic Health Initiatives

Organization Type: Local CCP Contact Title: VP, Medicare Advantage Sales & Marketing Plan Type: HMO/HMOPOS Name: Kim Heuss


CMS Region Responsible: Denver Fax: 1-253-779-8829 Enrollment: 273 Email: [email protected] Address: 32129

Weyerhaeuser Way S., Suite 201 Legal Entity Address: 2525 de Sales Ave

City: Federal Way City: Chattanooga State: WA


Legal Entity Name: COLORADO CHOICE HEALTH PLANS

Contract Number: H0657 Organization Marketing Name: Colorado Choice Health Plans

Parent Organization: Colorado Choice Health Plans

Organization Type: 1876 Cost Plan Type: 1876 Cost


CMS Region Responsible: Denver Enrollment: 825

Legal Entity Address: 700 Main Street Suite 100

City: Alamosa State: CO

Zip: 81101

Contact Title: Compliance Analyst Name:

Manuela Heredia Phone: 1-719-589-3696 Extension:

1783 Fax: 1-719-589-4901

Email: [email protected] Address: 700 Main Street, Suite 100

City: Alamosa State: CO


Legal Entity Name: COMMONWEALTH CARE ALLIANCE,

INC. Contract Number: H0137 Organization Marketing Name: Commonwealth Care Alliance, Inc.

Parent Organization: Commonwealth Care Alliance, Inc.

Organization Type: Demo Contact Title: Sr. Director of Regulatory Affairs Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Gail Coleman


CMS Region Responsible: Boston Fax: 1-617-426-3097 Enrollment: 10,760 Email: [email protected]

Address: 30 Winter Street Legal Entity Address: 30 Winter Street

12th Floor City: Boston City: Boston State: MA

State: MA Zip: 02108


Zip: 02108 Last Updated: 04/05/2013 Legal Entity Name: COMMONWEALTH CARE ALLIANCE,

INC. Contract Number: H2225 Organization Marketing Name: Commonwealth Care Alliance, Inc.

Parent Organization: Commonwealth Care Alliance, Inc.

Organization Type: Local CCP Contact Title: Sr. Director of Regulatory Affairs Plan Type: HMO/HMOPOS Name: Gail Coleman


CMS Region Responsible: Boston Fax: 1-617-426-3097 Enrollment: 6,638 Email: [email protected]

Address: 30 Winter Street Legal Entity Address: 30 WINTER STREET

City: Boston City: BOSTON State: MA

State: MA Zip: 02108 Zip: 02108 Last Updated: 04/05/2013

Legal Entity Name: COMMUNITY CARE ALLIANCE OF

ILLINOIS, NFP Contract Number: H3071 Organization Marketing Name: Community Care Alliance of

Illinois, NFP Parent Organization: Family Health Network

Organization Type: Local CCP Contact Title: Manager, Operations Plan Type: HMO/HMOPOS Name: Jason Huling



Address: 322 S Green St, Ste 400 Legal Entity Address: 322 S. Green Street

Suite 400 City: Chicago City: Chicago State: IL


Legal Entity Name: COMMUNITY CARE HEALTH PLAN,

INC. Contract Number: H2034 Organization Marketing Name: Community Care

Parent Organization: Community Care, Inc.




Legal Entity Address: 205 Bishops Way

City: Brookfield State: WI

Zip: 53005

Contact Title: Name: Provider Hotline Phone: 1-866-937-2783


Address: 1801 Dolphin Drive

City: Waukesha State: WI


Legal Entity Name: COMMUNITY CARE HEALTH PLAN, INC.

Contract Number: H5207 Organization Marketing Name: Community Care

Parent Organization: Community Care, Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Provider Hotline


CMS Region Responsible: Chicago Fax:


Enrollment: 268 Email: [email protected] Address: 1801 Dolphin Drive

Legal Entity Address: 205 Bishops Way City: Waukesha

City: Brookfield State: WI State: WI Zip: 53186

Zip: 53005 Last Updated: 02/17/2010 Legal Entity Name: COMMUNITY CARE HMO, INC

Contract Number: H3755 Organization Marketing Name: CommunityCare Senior Health Plan

(HMO) Parent Organization: CommunityCare Managed Healthcare

Plans of OK, Inc.

Organization Type: Local CCP Contact Title: Director, Member Services Plan Type: HMO/HMOPOS Name: Roxanne King



Address: 218 W 6th Street Legal Entity Address: 218 W. 6TH STREET

City: Tulsa City: TULSA State: OK

State: OK Zip: 74119 Zip: 74119 Last Updated: 12/14/2010

Legal Entity Name: COMMUNITY CARE, INC. Contract Number: H5212

Organization Marketing Name: Community Care Parent Organization: Community Care, Inc.

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Provider Hotline



Address: 1801 Dolphin Drive Legal Entity Address: 205 Bishops Way

City: Waukesha City: Brookfield State: WI

State: WI Zip: 53186 Zip: 53005 Last Updated: 02/17/2010

Legal Entity Name: COMMUNITY CAREPARTNERS, INC.

Contract Number: H6846 Organization Marketing Name: CarePartners PACE Parent

Organization: Mission Health




Legal Entity Address: 286 Overlook Road

City: Asheville State: NC

Zip: 28803

Contact Title: Executive Director Name: David Beijer Phone: 1-828-274-9567 Extension:

Fax: 1-828-277-4856 Email: [email protected] Address: 68

Sweeten Creek Road

City: Asheville State: NC



Legal Entity Name: COMMUNITY ELDERCARE OF SAN

DIEGO Contract Number: H5629 Organization Marketing Name: St. Paul's PACE

Parent Organization: Community Eldercare of San Diego

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Carol Hubbard



Address: 111 Elm Street Legal Entity Address: 111 Elm Street,

City: San Diego City: San Diego State: CA


Legal Entity Name: COMMUNITY HEALTH GROUP

Contract Number: H5172 Organization Marketing Name: Community Health Group

Parent Organization: Community Health Group


HMO/HMOPOS Name: Heidi Arndt



Address: 2420 Fenton Street Suite 100 Legal Entity Address: 2420 FENTON STREET, SUITE 100

City: Chula Vista City: CHULA VISTA State: CA


Legal Entity Name: COMMUNITY HEALTH PLAN OF

WASHINGTON Contract Number: H5826 Organization Marketing Name: Community HealthFirst Medicare

Advantage Plan Parent Organization: Community Health

Plan of Washington

Organization Type: Local CCP Contact Title: Customer Service Department Plan Type: HMO/HMOPOS Name: Customer Care



Address: 720 Olive Way Legal Entity Address: 720 Olive Way Suite 300

Suite 300 City: Seattle City: Seattle State: WA

State: WA Zip: 98101-1830 Zip: 981011830 Last Updated: 05/21/2010

Legal Entity Name: COMMUNITY INSURANCE

COMPANY Contract Number: H3655 Organization Marketing Name: Anthem Blue Cross and Blue Shield






Legal Entity Address: 4361 Irwin Simpson Road

City: Mason State: OH

Zip: 45040


Extension: Fax: Email: [email protected] Address:

145 S. Pioneer Road



Legal Entity Name: COMPCARE HEALTH SERVICES INSURANCE CORPORATION Contract Number: H9525

Organization Marketing Name: Anthem Blue Cross and Blue Shield Parent Organization:

Anthem Inc.



Address: 145 S. Pioneer Road Legal Entity Address: N17 W24340 Riverwood

City: Fon du Lac City: Waukesha State: WI State: WI Zip: 54935 Zip: 53188 Last Updated: 04/05/2013

Legal Entity Name: COMPLETE SENIOR CARE, INC.

Contract Number: H8777 Organization Marketing Name: Complete Senior Care

Parent Organization: Health Association of Niagara County,

Incorp.

Organization Type: National PACE Contact Title: Enrollment/Marketing Plan Type: National PACE Name: Virginia McAuliffe



Address: 1302 Main Street Legal Entity Address: 1302 Main Street

City: Niagara Falls City: Niagra Falls State: NY


Legal Entity Name: COMPREHENSIVE SENIOR CARE

CORPORATION Contract Number: H1310 Organization Marketing Name: CentraCare

Parent Organization: Comprehensive Senior Care Corporation

Organization Type: National PACE Contact Title: Chief Financial Officer/Interim CEO Plan Type: National PACE Name: Alexandria Lueth



Address: 200 West Michigan Avenue Legal Entity Address: 200 W. Michigan Avenue Suite 103

Suite 103 City: Battle Creek


City: Battle Creek State: MI State: MI Zip: 49017

Zip: 49017 Last Updated: 01/31/2015 Legal Entity Name: CONNECTICARE, INC. Contract Number: H3528

Organization Marketing Name: ConnectiCare, Inc. Parent Organization: EmblemHealth, Inc.




Legal Entity Address: 175 Scott Swamp Road

City: Farmington State: CT

Zip: 06032

Contact Title: Manager, Medicare Customer Service &

Direct Mktg Name: Brian Shoop Phone: 1-877-224-


Address: 175 Scott Swamp Road P.O. Box 4050

City: Farmington State: CT

Zip: 06034-4050 Last Updated: 11/10/2014

Legal Entity Name: CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC Contract Number:

H4556 Organization Marketing Name: Consolidated Assoc Of Railroad Employees Hc

Parent Organization: Consolidated Assoc of Railroad Employees HC Organization Type: HCPP - 1833 Cost Contact Title: Medicare Coordinator Plan Type: HCPP - 1833 Cost Name: Kathy

Hampton Contract Effective Date: 01/01/1992 Phone: 1-254-773-1330 Tax Status: Not-for-Profit/Non-Profit

Extension: 268 CMS Region Responsible: Dallas Fax: 1-254-774-8029 Enrollment: 2,990 Email: [email protected]

Address: P.O. Box 6130 Legal Entity Address:

4912 MIDWAY DR. P.O. BOX 6130 City: Temple City: TEMPLE State: TX State: TX Zip: 76503-6130 Zip: 76502 Last Updated: 07/26/2010

Legal Entity Name: CONSTELLATION HEALTH,

LLC. Contract Number: H3054 Organization Marketing Name: Constellation Health

Parent Organization: Constellation Health, LLC.

Organization Type: Local CCP Contact Title: Director of Operations Plan Type: HMO/HMOPOS Name: Roxana Rosario



Address: PO Box 360493 Legal Entity Address: 1064 Ponce de Le≤n

Avenue, Suite 500 City: San Juan City: San Juan State: PR

State: PR Zip: 00936 Zip: 00907 Last Updated: 05/12/2014




Organization Type: Local CCP Contact Title: Director of Operations Plan Type: Local PPO Name: Roxana Rosario




Address: PO Box 360493 Legal Entity Address: 1064 Ponce de Le≤n

Avenue, Suite 500 City: San Juan City: San Juan State: PR





Organization Type: Local CCP Contact Title: Director of Operations Plan Type: HMO/HMOPOS Name: Roxana Rosario



Address: PO Box 360493 Legal Entity Address: 1064 Ponce de Le≤n Ave,

Suite 500 City: San Juan City: San Juan State: PR


Legal Entity Name: COVENTRY HEALTH AND LIFE INSURANCE COMPANY Contract Number:

H1608 Organization Marketing Name: Coventry Health Care

Parent Organization: Aetna Inc. Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Aetna Customer Service

Contract Effective Date: 07/01/2005 Phone: 1-866-901-4692 Tax Status: For Profit Extension: CMS Region Responsible: Denver Fax: Enrollment: 30,552 Email: [email protected]

Address: 151 Farmington Avenue Legal Entity Address: 4320 114th Street

City: Hartford City: Urbandale State: CT State: IA Zip: 06156 Zip: 50322 Last Updated: 11/26/2014

Legal Entity Name: COVENTRY HEALTH CARE OF

ILLINOIS, INC. Contract Number: H7301 Organization Marketing Name: Coventry Health Care of Illinois,

Inc. Parent Organization: Aetna Inc.

Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Aetna Customer Service



Address: 151 Farmington Avenue Legal Entity Address: 2110 Fox Drive, Ste. A

City: Hartford City: Champaign State: CT

State: IL Zip: 06156


Zip: 61820 Last Updated: 11/26/2014 Legal Entity Name: COVENTRY HEALTH CARE OF

KANSAS, INC. Contract Number: H2672 Organization Marketing Name: Coventry Health Care





Address: 151 Farmington Avenue Legal Entity Address: 9401 Indian Creek Parkway Suite

1300 City: Hartford City: Overland Park State: CT

State: KS Zip: 06156 Zip: 66210 Last Updated: 11/25/2014


MISSOURI, INC Contract Number: H2663 Organization Marketing Name: Coventry Health Care of Missouri,

Inc. Parent Organization: Aetna Inc.




Legal Entity Address: 550 Maryville Centre Drive Suite 300

City: St. Louis State: MO

Zip:

631415818

Contact Title: Name: Aetna Customer Service Phone: 1-800-533-






MISSOURI, INC Contract Number: H2667 Organization Marketing Name: Coventry Health Care





Address: 151 Farmington Avenue Legal Entity Address: 550 Maryville Center Dr.

Suite 300 City: Hartford City: St. Louis State: CT



NEBRASKA, INC. Contract Number: H7149 Organization Marketing Name: Coventry Health Care






Address: 151 Farmington Avenue Legal Entity Address: 15950 West Dodge Road

City: Hartford City: Omaha State: CT

State: NE Zip: 06156 Zip: 681184030 Last Updated: 11/26/2014

Legal Entity Name: COVENTRY HEALTH CARE OF WEST

VIRGINIA, INC. Contract Number: H1692 Organization Marketing Name: Coventry Health Care





Address: 151 Farmington Avenue Legal Entity Address: 500 Virginia St SE

Suite 400 City: Hartford City: Charleston State: CT

State: WV Zip: 06156 Zip: 25301 Last Updated: 11/26/2014

Legal Entity Name: CRESTPOINT HEALTH INSURANCE

COMPANY Contract Number: H0879 Organization Marketing Name: CrestPoint Health Insurance

Company Parent Organization: Mountain States Health

Alliance

Organization Type: Local CCP

Plan Type: Local PPO Contract

Effective Date: 01/01/2013 Tax Status: For Profit

CMS Region Responsible: Atlanta Enrollment: 5,287

Legal Entity Address: 509 Med Tech Parkway Suite 100

City: Johnson City State: TN

Zip: 37604

Contact Title: VP, Chief Operations Officer Name: Sylvia A Sherrill Phone: 1-888-350-7537


Address: 509 Med Tech Parkway Suite 100

City: Johnson City State: TN


Legal Entity Name: CUATRO LLC Contract Number: H4866

Organization Marketing Name: Access

Medicare Parent Organization: Cuatro

LLC.

Organization Type: Local CCP Contact Title: Manager, Enrollment Plan Type: HMO/HMOPOS Name: Shantel Valentin



Address: 5030 Broadway Legal Entity Address: 93-20 Roosevelt Avenue Suite 664

Suite 3C City: New York City: Jackson Heights State: NY



Legal Entity Name: DEAN HEALTH PLAN, INC. Contract

Number: H5264 Organization Marketing Name: Dean Health Plan, Inc.

Parent Organization: Dean Health Systems Inc.

Organization Type: 1876 Cost Contact Title: [email protected] Plan Type: 1876 Cost Name: Jamie Logsdon



Address: 1277 Deming Way Legal Entity Address: 1277 DEMING WAY

City: Madison City: MADISON State: WI


Legal Entity Name: DENVER HEALTH MEDICAL PLAN, INC.

Contract Number: H5608 Organization Marketing Name: Denver Health Medical Plan, Inc.

Parent Organization: Denver Health and Hospital Authority

Organization Type: Local CCP Contact Title: Government Product Specialist Plan Type: HMO/HMOPOS Name: Diane Kirsch


CMS Region Responsible: Denver Fax: 1-303-602-2094 Enrollment: 4,331 Email: [email protected]

Address: 777 Bannock Street Legal Entity Address: 777 Bannock Street Mail Code 6000

Mail Code 6000 City: Denver City: Denver State: CO

State: CO Zip: 80204 Zip: 80204 Last Updated: 04/25/2014

Legal Entity Name: EASY CHOICE HEALTH PLAN INC.

Contract Number: H5087 Organization Marketing Name: Easy Choice Health Plan

Parent Organization: WellCare Health Plans, Inc.




Legal Entity Address: 180 E. Ocean Blvd Suite 700

City: Long Beach State: CA Zip: 90802

Contact Title: Membership Operations Department Name: Customer Service Phone: 1-866-999-3945 Extension:

Fax: 1-877-999-3945 Email: [email protected] Address: 180 E.

Ocean Blvd. Suite 700

City: Long Beach State: CA


Legal Entity Name: ELDER SVC PLAN OF THE CAMBRIDGE HEALTH ALLIANCE Contract

Number: H2221 Organization Marketing Name: Elder Srvc Pln/Cambridge Health Alliance Parent

Organization: Cambridge Health Alliance


Organization Type: National PACE Contact Title: Manager of Finance & Information Services Plan Type: National PACE Name: Estenieau Jean


Extension: CMS Region Responsible: Boston Fax: 1-617-665-3110 Enrollment: 287 Email: [email protected]

Address: 270 Green Street Legal Entity Address: 270 GREEN STREET

City: Cambridge City: CAMBRIDGE State: MA State: MA Zip: 02139 Zip: 02139 Last Updated: 05/02/2011

Legal Entity Name: ELDER SVC PLN/E BOSTON

HEALTH CENTER Contract Number: H2223 Organization Marketing Name: Elder Svc Pln/E Boston Health

Center Parent Organization: Elder Svc Pln/E Boston

Health Center

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Pamela Pattavina


CMS Region Responsible: Boston Fax: Enrollment: 407 Email: [email protected]

Address: 10 Gove St Legal Entity Address: 10 GOVE STREET

City: East Boston City: EAST BOSTON State: MA


Legal Entity Name: ELDERHAUS INC. Contract Number: H3942

Organization Marketing Name: Elderhaus PACE Parent

Organization: Elderhaus Inc.

Organization Type: National PACE Contact Title: CEO Plan Type: National PACE Name: Rick Richards


CMS Region Responsible: Atlanta Fax: 1-910-343-8836 Enrollment: 103 Email: [email protected] Address: 2222 S. 17th

St. Legal Entity Address: 2222 S. 17th St.

City: Wilmington City: Wilmington State: NC


Legal Entity Name: ELDERPLAN, INC. Contract Number: H3347

Organization Marketing Name: Elderplan Parent Organization: Elderplan, Inc.





Legal Entity Address: 6323 SEVENTH AVENUE

City: BROOKLYN State: NY

Zip: 112204711

Contact Title: Director of Customer Services Name: Richard

Rutherford Phone: 1-718-921-7979 Extension:

Fax: 1-718-765-8885 Email: [email protected] Address: 745 64th

Street

City: Brooklyn State: NY


Legal Entity Name: ELDERPLAN, INC. Contract Number: H8029

Organization Marketing Name: Elderplan FIDA Total Care Parent

Organization: Elderplan, Inc.

Organization Type: Demo Contact Title: Director of Customer Services Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Richard Rutherford


CMS Region Responsible: New York Fax: 1-718-921-8824 Enrollment: 353 Email: [email protected] Address: 6323

Seventh Avenue Legal Entity Address: 6323 Seventh Avenue

City: Brooklyn City: Brooklyn State: NY


Legal Entity Name: ELDERSERVE HEALTH, INC. Contract

Number: H6435 Organization Marketing Name: RiverSpring FIDA Plan

Parent Organization: Riverspring Health Holding Corp.

Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Provider Services



Address: 94 West 225th Street, 2nd floor Legal Entity Address: 94 West 225th Street, 2nd floor

City: Bronx City: Bronx State: NY


Legal Entity Name: ELEMENT CARE, INC. Contract Number: H2222

Organization Marketing Name: Element Care, Inc Parent Organization: Element Care, Inc.

Organization Type: National PACE Contact Title: Director Marketing Plan Type: National PACE Name: Rachel Kestner


CMS Region Responsible: Boston Fax: 1-781-715-6699 Enrollment: 885 Email: [email protected]

Address: 37 Friend Street Legal Entity Address: 37 FRIEND STREET

City: Lynn City: LYNN State: MA



Legal Entity Name: EMPIRE HEALTHCHOICE ASSURANCE,

INC. Contract Number: H3342 Organization Marketing Name: Empire BlueCross BlueShield



Plan Type: Local PPO Contract

Effective Date: 09/01/2005 Tax Status: For Profit


Legal Entity Address: 1 Liberty Plaza 165 Broadway City:

New York State: NY Zip:

10006






Legal Entity Name: EMPIRE HEALTHCHOICE

HMO, INC. Contract Number: H3370 Organization Marketing Name: Empire BlueCross

BlueShield Parent Organization: Anthem Inc.




Address: 145 S. Pioneer Road Legal Entity Address: 1 Liberty Plaza

165 Broadway City: Fon du Lac City: New York State: WI


Legal Entity Name: ESSENCE HEALTHCARE,

INC. Contract Number: H2610 Organization Marketing Name: Essence Healthcare

Parent Organization: Essence Group Holdings

Corporation



CMS Region Responsible: Kansas City Fax: 1-314-770-6096 Enrollment: 52,424 Email: [email protected]

Address: 13900 Riverport Drive Legal Entity Address: 13900 Riverport Drive

City: Maryland Heights City: Maryland Heights State: MO


Legal Entity Name: EXCELLUS HEALTH PLAN,

INC. Contract Number: H3335 Organization Marketing Name: Excellus Health Plan, Inc

Parent Organization: Lifetime Healthcare, Inc.

Organization Type: Local CCP Contact Title: Customer Service Department Plan Type: Local PPO Name: * Customer Service




Address: 205 Park Club Lane Legal Entity Address: 165 Court St.

City: Buffalo City: Rochester State: NY


Legal Entity Name: EXCELLUS HEALTH PLAN,

INC. Contract Number: H3351 Organization Marketing Name: Excellus Health Plan, Inc

Parent Organization: Lifetime Healthcare, Inc.




Legal Entity Address: 165 Court Street

City: Rochester State: NY Zip:

14647

Contact Title: Customer Service Department

Name: * Customer Service Phone: 1-877-883-


Address: 205 Park Club Lane

City: Buffalo State: NY


Legal Entity Name: FALLON COMMUNITY

HEALTH PLAN Contract Number: H2219 Organization Marketing Name: Summit ElderCare or

Fallon Health Parent Organization: Fallon

Community Health Plan

Organization Type: National PACE Contact Title: Pace Business Consultant Plan Type: National PACE Name: Elizabeth Sabourin



Address: One Chestnut Place Legal Entity Address: 10 CHESTNUT STREET 10 Chestnut Street

City: Worcester City: WORCESTER State: MA



HEALTH PLAN Contract Number: H2411 Organization Marketing Name: Fallon Health

Parent Organization: Fallon Community Health

Plan




Address: One Chestnut Place Legal Entity Address: 10 CHESTNUT STREET 10 Chestnut Street

City: Worcester City: WORCESTER State: MA




HEALTH PLAN Contract Number: H9001 Organization Marketing Name: Fallon Health


Plan




Address: One Chestnut Place Legal Entity Address: ONE CHESTNUT PLACE 10 Chestnut Street

10 CHESTNUT STREET City: Worcester City: WORCESTER State: MA


Legal Entity Name: FALLON HEALTH

WEINBERG, INC Contract Number: H2470 Organization Marketing Name: Fallon Health Weinberg


Plan



CMS Region Responsible: Boston Fax: Enrollment: 35 Email:

[email protected] Address: 461 John James Audubon Parkway

Legal Entity Address: 461 John James Audubon

Parkway City: Amherst City: Amherst State: NY


Legal Entity Name: FALLON HEALTH

WEINBERG, INC. Contract Number: H6596 Organization Marketing Name: Fallon Health Weinberg-

PACE Parent Organization: Fallon Community Health

Plan

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Customer Service


CMS Region Responsible: New York Fax: Enrollment: * Email: [email protected]

Address: 461 John James Audubon Parkway Legal Entity Address: 461 John James Audobon

Parkway City: Amherst City: Amherst State: NY


Legal Entity Name: FAMILYCARE HEALTH

PLANS, INC. Contract Number: H0840 Organization Marketing Name: FamilyCare Health Plans,

Inc. Parent Organization: FamilyCare Incorporated

Organization Type: Local CCP Contact Title: Program Integrity Manager Plan Type: Local PPO Name: Johanna Watson



CMS Region Responsible: Seattle Fax: 1-503-471-2195 Enrollment: 110 Email: [email protected]

Address: 825 NE Multnomah, Suite

1400 Legal Entity Address: 825 NE MULTNOMAH,

SUITE 1400 City: Portland City: PORTLAND State: OR


Legal Entity Name: FAMILYCARE HEALTH

PLANS, INC. Contract Number: H3818 Organization Marketing Name: FamilyCare Health Plans,

Inc. Parent Organization: FamilyCare Incorporated

Organization Type: Local CCP Contact Title: Program Integrity Manager Plan Type: HMO/HMOPOS Name: Johanna Watson



Address: 825 NE Multnomah, Suite

1400 Legal Entity Address: 825 NE MULTNOMAH,



Legal Entity Name: FIDELIS SECURECARE OF

MICHIGAN Contract Number: H9487 Organization Marketing Name: Fidelis SecureCare of

Michigan Parent Organization: Centene

Corporation




CMS Region Responsible: Chicago Fax: Enrollment: 5,387 Email:

[email protected] Address: 7700 Forsyth Blvd

Legal Entity Address: 7700 Forsyth City: St. Louis

City: St Louis State: MO State: MO Zip: 63105


Legal Entity Name: FIRSTCAROLINACARE INSURANCE

COMPANY Contract Number: H6306 Organization Marketing Name: FirstCarolinaCare Insurance

Company Parent Organization: FirstHealth of the

Carolinas, Inc.

Organization Type: Local CCP Contact Title: Compliance Analyst Plan Type: HMO/HMOPOS Name: Abiola Aluko



Address: 42 Memorial Drive


Legal Entity Address: 42 Memorial Dr City: Pinehurst

City: Pinehurst State: NC State: NC Zip: 28374

Zip: 28374 Last Updated: 04/21/2015 Legal Entity Name: FIRSTCAROLINACARE INSURANCE

COMPANY Contract Number: H8064 Organization Marketing Name: FirstCarolinaCare Insurance

Company Parent Organization: FirstHealth of the

Carolinas, Inc.

Organization Type: Local CCP Contact Title: Compliance Analyst Plan Type: Local PPO Name: Abiola Aluko



Address: 42 Memorial Drive Legal Entity Address: 42 Memorial Dr

City: Pinehurst City: Pinehurst State: NC


Legal Entity Name: FLORIDA HEALTH CARE PLAN, INC.

Contract Number: H1035 Organization Marketing Name: Florida Health Care Plans


Organization Type: Local CCP Contact Title: Manager of Government Contracts Plan Type: HMO/HMOPOS Name: Christine Laks


CMS Region Responsible: Atlanta Fax: 1-386-615-4045 Enrollment: 13,120 Email: [email protected]

Address: 1340 Ridgewood Avenue Legal Entity Address: 1340 Ridgewood Avenue

City: Holly Hill City: Holly Hill State: FL


Legal Entity Name: FLORIDA PACE CENTERS, INC.

Contract Number: H1043 Organization Marketing Name: Florida Pace Centers, Inc.

Parent Organization: Florida PACE Centers, Inc.




Legal Entity Address: 5200 NE 2ND AVENUE

City: MIAMI State: FL

Zip: 33137

Contact Title: Senior Manager, Marketing Name: Noemi Sanchez Phone: 1-305-762-1388

Extension: Fax: Email: [email protected] Address: 5200

NE 2nd Avenue

City: Miami State: FL



Legal Entity Name: FRANCISCAN ALLIANCE, INC. Contract

Number: H5124 Organization Marketing Name: Franciscan Senior Health & Wellness

Parent Organization: Franciscan Alliance, Inc.

Organization Type: National PACE Contact Title: Director of PACE Plan Type: National PACE Name: Susan Waschevski



Address: 700 East Southport Rd Legal Entity Address: 700 E. Southport Road 8325

Southport Road Ste. 120 City: Indianapolis City: Indianapolis State: IN


Legal Entity Name: FRANCISCAN PACE, INC.

Contract Number: H6231 Organization Marketing Name: PACE Baton Rouge

Parent Organization: Franciscan Missionaries of Our Lady Health

System

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Karen Allen



Address: 7436 Bishop Ott Drive Legal Entity Address: 7436 Bishop Ott Drive

City: Baton Rouge City: Baton Rouge State: LA

State: LA Zip: 70806 Zip: 70806 Last Updated: 03/13/2009

Legal Entity Name: FREEDOM HEALTH, INC. Contract Number: H5427

Organization Marketing Name: Freedom Health, Inc. Parent Organization: America's 1st Choice Holdings of Florida, LLC

Organization Type: Local CCP Contact Title: Sr. VP Operations Plan Type: HMO/HMOPOS Name: Chris O'Connor



Address: 3707 W. Cherry Street Legal Entity Address: 5403 N Church Avenue

City: Tampa City: Tampa State: FL


Legal Entity Name: GATEWAY HEALTH PLAN OF OHIO, INC.

Contract Number: H9190 Organization Marketing Name: Gateway Health Medicare Assured

Parent Organization: Gateway Health Plan, LP





Legal Entity Address: Four Gateway Center 444 Liberty Avenue, Suite 2100 City:

Pittsburgh State: PA

Zip: 15222

Contact Title: Name: Gateway Health Plan Phone: 1-800-685-5209


Four Gateway Center 444 Liberty Avenue, Suite 2100 City:



Legal Entity Name: GATEWAY HEALTH PLAN, INC.

Contract Number: H5932 Organization Marketing Name: Gateway Health Medicare Assured

Parent Organization: Gateway Health Plan, LP

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Gateway Health Plan


CMS Region Responsible: Philadelphia Fax: Enrollment: 50,175 Email: [email protected] Address:

Four Gateway Center Legal Entity Address: Four Gateway Center 444 Liberty Avenue, Suite 2100

444 Liberty Avenue, Suite 2100 City: Pittsburgh City: Pittsburgh State: PA


Legal Entity Name: GEISINGER COMMUNITY HEALTH

SERVICES Contract Number: H2064 Organization Marketing Name: LIFE Geisinger

Parent Organization: Geisinger Health System

Organization Type: National PACE Contact Title: Director LIFE Geisinger Plan Type: National PACE Name: Robert E McQuillan



Address: 100 North Academy Avenue Legal Entity Address: 100 North Academy Avenue MC 24-12

MC 24-12 City: Danville City: Danville State: PA


Legal Entity Name: GEISINGER HEALTH PLAN Contract

Number: H3954 Organization Marketing Name: Geisinger Gold


Organization Type: Local CCP Contact Title: Geisinger Health Plan Plan Type: HMO/HMOPOS Name: Customer Service



Address: 100 North Academy Avenue Legal Entity Address: 100 NORTH ACADEMY AVENUE

City: Danville City: DANVILLE State: PA



Legal Entity Name: GEISINGER INDEMNITY INSURANCE

COMPANY Contract Number: H3924 Organization Marketing Name: Geisinger Gold







Legal Entity Address: 100 NORTH ACADEMY AVE.

City: DANVILLE State: PA

Zip: 178223220

Contact Title: Geisinger Health Plan

Name: Customer Service Phone: 1-570-498-9731


Email:

[email protected]

Address: 100 North Academy Avenue

City: Danville State: PA

Zip: 17822-3229 Last Updated: 03/10/2015

Legal Entity Name: GEISINGER QUALITY

OPTIONS, INC. Contract Number: H9412 Organization Marketing Name: Geisinger Gold


Organization Type: Local CCP Contact Title: Geisinger Health Plan Plan Type: Local PPO Name: Customer Service



Address: 100 North Academy Avenue Legal Entity Address: 100 North Academy Ave

City: Danville City: Danville State: PA


Legal Entity Name: GEMCARE HEALTH PLAN

INC. Contract Number: H5609 Organization Marketing Name: Blue Shield of California

Parent Organization: California Physicians'

Service

Organization Type: Local CCP Contact Title: Marketing Manager Plan Type: HMO/HMOPOS Name: Ana Igoa


CMS Region Responsible: San Francisco Fax: Enrollment: 8,131 Email: [email protected]

Address: 4550 California Avenue Legal Entity Address: 4550 California Avenue Suite 100

Suite 100 City: Bakersfield City: Bakersfield State: CA


Legal Entity Name: GENERATIONS

HEALTHCARE, INC. Contract Number: H3706 Organization Marketing Name: Generations Healthcare

Parent Organization: Kinderhook Capital Fund III,

L.P.


Organization Type: Local CCP Contact Title: Vice President of Health Plan Operations Plan Type: HMO/HMOPOS Name: David Thompson



Address: 6120 S Yale Avenue Legal Entity Address: 701 NE 10th ST Suite 925

Suite 300 City: Tulsa City: Oklahoma City State: OK


Legal Entity Name: GENESYS HEALTH SYSTEM

Contract Number: H8769 Organization Marketing Name: Genesys PACE of

Genesee County Parent Organization: Genesys

Health System



CMS Region Responsible: Chicago Enrollment: *

Legal Entity Address: One Genesys Parkway

City: Grand Blanc State: MI

Zip: 48439

Contact Title: Quality Assurance coordinator Name: Kathryn Liley Phone: 1-810-236-7500



Address: 412 E First Street

City: flint State: MI


Legal Entity Name: GHS HEALTH MAINTENANCE

ORGANIZATION, INC. Contract Number: H3979 Organization Marketing Name: Blue Cross Blue Shield of OK

Parent Organization: Health Care Service Corporation




Address: P.O. Box 4109 Legal Entity Address: 1400 S Boston Ave

City: Scranton City: Tulsa State: PA


Legal Entity Name: GHS INSURANCE COMPANY Contract

Number: H8133 Organization Marketing Name: Blue Cross and Blue Shield of Texas




CMS Region Responsible: Dallas Fax: Enrollment: 711 Email: [email protected] Address: P.O.

Box 4109 Legal Entity Address: 3817 Northwest Expressway

Suite 300 City: Scranton


City: Oklahoma City State: PA State: OK Zip: 18505

Zip: 73112 Last Updated: 02/12/2015 Legal Entity Name: GHS MANAGED HEALTH CARE PLANS,

INC. Contract Number: H6801 Organization Marketing Name: Blue Cross Blue Shield of Oklahoma





Address: P.O. Box 4109 Legal Entity Address: 1400 S. Boston

City: Scranton City: Tulsa State: PA


Legal Entity Name: GLOBALHEALTH, INC. Contract Number: H0435

Organization Marketing Name: GLOBALHEALTH MEDICARE Parent Organization: Kinderhook Capital Fund III, L.P.




Legal Entity Address: 701 NE 10th Street Suite 300

City: Oklahoma City State: OK

Zip: 731045403

Contact Title: Vice President of Health Plan Operations Name: David Thompson Phone: 1-918-878-7306


Email: [email protected] Address: 6120 S Yale Avenue

Suite 925 City: Tulsa

State: OK Zip: 74136

Last Updated: 04/02/2012

Legal Entity Name: GOLDEN STATE MEDICARE

HEALTH PLAN Contract Number: H2241 Organization Marketing Name: Golden State Medicare

Health Plan Parent Organization: Golden State

Medicare Health Plan

Organization Type: Local CCP Contact Title: Enrollment Supervisor Plan Type: HMO/HMOPOS Name: Martha Davis



Address: 3030 Old Ranch Pkwy Legal Entity Address: 3030 Old Ranch Pkwy Suite 155

Suite 155 City: Seal Beach City: Seal Beach State: CA


Legal Entity Name: GROUP HEALTH COOPERATIVE

Contract Number: H5050 Organization Marketing Name: Group Health Cooperative

Parent Organization: Group Health Cooperative

Organization Type: Local CCP Contact Title: Health Plan Operations Plan Type: HMO/HMOPOS Name: Provider Assistance Unit




Address: Group Health Cooperative, Provider Assistance

Unit Legal Entity Address: 320 Westlake Avenue North,

Suite 100 PO Box 34585

Attn: Medicare Programs &

Compliance City: Seattle

City: SEATTLE State: WA State: WA Zip: 98124-1585

Zip: 981095233 Last Updated: 06/02/2008 Legal Entity Name: GROUP HEALTH

INCORPORATED Contract Number: H5528 Organization Marketing Name: EmblemHealth Medicare PPO

Parent Organization: EmblemHealth, Inc.

Organization Type: Local CCP Contact Title: Director, Customer Service Plan Type: Local PPO Name: Heather Lacy



Address: 3251 Hollywood Blvd Legal Entity Address: 80 Wolf Road

6th Floor City: Hollywood City: Albany State: FL


Legal Entity Name: GROUP HEALTH PLAN, INC. (MN)

Contract Number: H2462 Organization Marketing Name: HealthPartners

Parent Organization: HealthPartners, Inc.




Legal Entity Address: 8170 33rd Avenue South PO Box 1309

City: MINNEAPOLIS State: MN

Zip: 55425

Contact Title: Name: Provider Services Phone: 1-952-883-7699


Address: 8170 33rd Avenue South, PO Box 1309

City: Minneapolis State:

MN Zip: 55440-1309


Legal Entity Name: GUILDNET, INC. Contract Number: H0811

Organization Marketing Name: GuildNet Gold Plus FIDA Parent Organization: Lighthouse Guild International

Organization Type: Demo Contact Title: Assistant VP, Medicare Services Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Sandra Birnbaum



Address: 15 West 65th Street Legal Entity Address: 15 W 65th Street




Legal Entity Name: GUILDNET, INC. Contract Number: H6864

Organization Marketing Name: GuildNet Parent Organization: Lighthouse Guild International

Organization Type: Local CCP Contact Title: Assistant VP, Medicare Services Plan Type: HMO/HMOPOS Name: Sandra Birnbaum


CMS Region Responsible: New York Fax: 1-212-769-1621 Enrollment: 654 Email: [email protected]

Address: 15 West 65th Street Legal Entity Address: 15 WEST 65TH STREET

City: New York City: NEW YORK State: NY


Legal Entity Name: GUNDERSEN HEALTH PLAN Contract

Number: H5262 Organization Marketing Name: Gundersen Health Plan, Inc.

Parent Organization: Gundersen Lutheran Health System Inc.




Address: 1900 South Avenue Legal Entity Address: 1900 South Avenue Mailstop: NCA2-01

Mailstop NCA2-01 City: La Crosse City: La Crosse State: WI


Legal Entity Name: GUNDERSEN HEALTH PLAN OF

MINNESOTA Contract Number: H9834 Organization Marketing Name: Gundersen Health Plan Minnesota

Parent Organization: Gundersen Lutheran Health System Inc.




Legal Entity Address: 1900 South Avenue

City: LaCrosse State: WI

Zip: 54601

Contact Title: Name: Customer Service Phone: 1-800-394-5566 Extension:

58077 Fax: 1-608-775-8091

Email: [email protected] Address: 1900 South Avenue

Mailstop: NCA2-01 City: La Crosse

State: WI Zip: 54601


Legal Entity Name: HAP MIDWEST HEALTH PLAN, INC.

Contract Number: H5685 Organization Marketing Name: HAP Midwest Advantage


Organization Type: Local CCP Contact Title: Vice President - Medicare Plan Type: HMO/HMOPOS Name: Brian Peltz




Address: 4700 SCHAEFER ROAD Legal Entity Address: 4700 Schaefer Road Ste 340

Suite 340 City: DEARBORN City: Dearborn State: MI


Legal Entity Name: HAP MIDWEST HEALTH PLAN, INC.

Contract Number: H9712 Organization Marketing Name: HAP Midwest MI Health Link


Organization Type: Demo Contact Title: Vice President - Medicare Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Brian Peltz



Address: 4700 SCHAEFER ROAD Legal Entity Address: 4700 Schaefer Road Ste 340

Ste. 340 City: DEARBORN City: Dearborn State: MI


Legal Entity Name: HARBOR HEALTH PLAN, INC.

Contract Number: H7960 Organization Marketing Name: Harbor Medicare Plans





Address: 3663 Woodward Avenue Legal Entity Address: 3663 Woodward Avenue Suite 120

Suite 120 City: Detroit City: Detroit State: MI


Legal Entity Name: HARBOR HEALTH SERVICES,

INC. Contract Number: H2218 Organization Marketing Name: Elder Service Plan of Harbor

Health Services, Inc Parent Organization: Harbor Health

Services, Inc.



CMS Region Responsible: Boston Enrollment: 441

Legal Entity Address: 1135 Morton Street

City: Mattapan State: MA

Zip: 02126

Contact Title: Community Outreach

Manager Name: Lisa Yorra Phone: 1-617-533-2400


Email: [email protected] Address: 1135 Morton Street

City: Mattapan State: MA



Legal Entity Name: HARMONY HEALTH PLAN OF

ILLINOIS, INC. Contract Number: H1416 Organization Marketing Name: WellCare


Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Website Inquiries



Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: 125 SOUTH WACKER DRIVE

SUITE 2600 City: Tampa City: CHICAGO State: FL


Legal Entity Name: HARVARD PILGRIM HEALTH

CARE INC. Contract Number: H1660 Organization Marketing Name: Harvard Pilgrim Health Care,

Inc. Parent Organization: Harvard Pilgrim Health Care,

Inc.

Organization Type: Local CCP Contact Title: Market Manager, Senior Programs Plan Type: HMO/HMOPOS Name: Jonathan Holway



Address: 93 Worcester Street Legal Entity Address: 93 Worcester St

City: Wellesley City: Wellesley State: MA


Legal Entity Name: HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC. Contract

Number: H6750 Organization Marketing Name: Harvard Pilgrim Health Care of New England, Inc.

Parent Organization: Harvard Pilgrim Health Care, Inc. Organization Type: Local CCP Contact Title: Market Manager, Senior Programs Plan Type: HMO/HMOPOS Name: Jonathan Holway


Extension: CMS Region Responsible: Boston Fax: Enrollment: 1,469 Email: [email protected]

Address: 93 Worcester Street Legal Entity Address: 93 Worcester St

City: Wellesley City: Wellesley State: MA State: MA Zip: 02481 Zip: 02481 Last Updated: 07/21/2014

Legal Entity Name: HAWAII MEDICAL SERVICE

ASSOCIATION Contract Number: H3832 Organization Marketing Name: Akamai Advantage by HMSA

Parent Organization: Hawaii Medical Service Association



Plan Type: Local PPO Contract Effective Date: 01/01/2011

Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: San Francisco

Enrollment: 37,045

Legal Entity Address: 818 Keeaumoku Street


Zip: 968142365

Contact Title: Manager Name: Kevin Unger Phone: 1-800-790-


Address: 5 - CR 5 - CR



Legal Entity Name: HCSC INSURANCE SERVICES

COMPANY Contract Number: H1666 Organization Marketing Name: Blue Cross Blue Shield of

Texas Parent Organization: Health Care Service Corporation




Address: P.O. Box 4109 Legal Entity Address: 300 E Randolph St

City: Scranton City: Chicago State: PA


Legal Entity Name: HEALTH ALLIANCE - MIDWEST,

INC. Contract Number: H1737 Organization Marketing Name: Health Alliance Medicare

Parent Organization: The Carle Foundation

Organization Type: Local CCP Contact Title: Director Medicare Services Plan Type: HMO/HMOPOS Name: Jennifer Marquardt



Address: 301 S. Vine St. Legal Entity Address: 301 South Vine Street

City: Urbana City: Urbana State: IL


Legal Entity Name: HEALTH ALLIANCE - MIDWEST,

INC. Contract Number: H2591 Organization Marketing Name: Health Alliance Medicare


Organization Type: Local CCP Contact Title: Director edicare Services Plan Type: Local PPO Name: Jennifer Marquardt



Address: 301 S. Vine St.


Legal Entity Address: 301 South Vine Street City: Urbana

City: Urbana State: IL State: IL Zip: 61801

Zip: 61801 Last Updated: 02/02/2015 Legal Entity Name: HEALTH ALLIANCE CONNECT

Contract Number: H0773 Organization Marketing Name: Health Alliance Connect


Organization Type: Demo Contact Title: Director Medicare Services Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Jennifer Marquardt



Address: 301 S. Vine St. Legal Entity Address: 301 S. Vine Street



Legal Entity Name: HEALTH ALLIANCE

CONNECT, INC. Contract Number: H1417 Organization Marketing Name: Health Alliance Medicare


Organization Type: Local CCP Contact Title: Director Medicare Services Plan Type: Local PPO Name: Jennifer Marquardt



Address: 301 S. Vine St. Legal Entity Address: 301 S Vine St

PO Box 6003 City: Urbana City: URBANA State: IL





Organization Type: Local CCP Contact Title: Director Medicare Services Plan Type: HMO/HMOPOS Name: Jennifer Marquardt



Address: 301 S. Vine St. Legal Entity Address: 301 S Vine St

PO Box 6003 City: Urbana City: URBANA State: IL






Organization Type: Local CCP Contact Title: Director edicare Services Plan Type: HMO/HMOPOS Name: Jennifer Marquardt



Address: 301 S. Vine St. Legal Entity Address: 301 South Vine Street



Legal Entity Name: HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.

Contract Number: H3471 Organization Marketing Name: Health Alliance Medicare

Parent Organization: The Carle Foundation Organization Type: Local CCP Contact Title: Director Medicare Services Plan Type: HMO/HMOPOS Name: Jennifer Marquardt

Contract Effective Date: 01/01/2014 Phone: 1-877-750-3350 Tax Status: For Profit Extension: CMS Region Responsible: Chicago Fax: 1-217-337-3425 Enrollment: 3,977 Email: [email protected]

Address: 301 S. Vine St. Legal Entity

Address: 820 N Chelan Ave PO Box 810 City: Urbana City: Wenatchee State: IL State: WA Zip: 61801 Zip: 98801 Last Updated: 02/24/2015

Legal Entity Name: HEALTH ALLIANCE PLAN OF

MICHIGAN Contract Number: H2312 Organization Marketing Name: HAP Senior Plus


Organization Type: Local CCP Contact Title: VP - Client Services Plan Type: HMO/HMOPOS Name: Richard Chaney



Address: 2850 W. Grand

Blvd. Legal Entity Address: 2850 W. GRAND BLVD.

City: Detroit City: DETROIT State: MI


Legal Entity Name: HEALTH CARE SERVICE

CORPORATION Contract Number: H0107 Organization Marketing Name: Blue Cross and Blue Shield of

Montana Parent Organization: Health Care Service

Corporation






Address: P.O. Box 4109 Legal Entity Address: 300 East Randolph




CORPORATION Contract Number: H0927 Organization Marketing Name: Blue Cross Community MMAI



HMO/HMOPOS Name: Customer Service



Address: P.O. Box 3836 Legal Entity Address: 300 E. Randolph




CORPORATION Contract Number: H3251 Organization Marketing Name: Lovelace Medicare Plan





Legal Entity Address: 300 East Randolph

City: Chicago State: IL

Zip: 60601




City: Scranton State: PA



CORPORATION Contract Number: H3822 Organization Marketing Name: Blue Cross Blue Shield of IL,

MT, NM Parent Organization: Health Care Service

Corporation




Address: P.O. Box 4109 Legal Entity Address: 300 E Randolph St





CORPORATION Contract Number: H8634 Organization Marketing Name: Blue Cross and Blue Shield of

IL, NM, OK Parent Organization: Health Care Service

Corporation




Address: P.O. Box 4109 Legal Entity Address: 300 E. Randolph St



Legal Entity Name: HEALTH CHOICE ARIZONA,

INC. Contract Number: H5587 Organization Marketing Name: Health Choice Generations

HMO SNP Parent Organization: IASIS Healthcare

Organization Type: Local CCP Contact Title: Compliance Officer Plan Type: HMO/HMOPOS Name: Jessica Meade



Address: 410 N 44th Street, Suite 510 Legal Entity Address: 410 N 44th Street

Suite 510 City: Phoenix City: Phoenix State: AZ


Legal Entity Name: HEALTH FIRST HEALTH PLANS

Contract Number: H1099 Organization Marketing Name: Health First Health Plans, Inc.

Parent Organization: Health First, Inc.




Legal Entity Address: 6450 US HIGHWAY 1

City: ROCKLEDGE State: FL

Zip: 329555747



6450 US Highway 1

City: Rockledge State: FL


Legal Entity Name: HEALTH INSURANCE PLAN OF GREATER NEW YORK Contract Number: H3314

Organization Marketing Name: HIP Health Plan of Greater New York Parent Organization:

EmblemHealth, Inc.


Organization Type: 1876 Cost Contact Title: Director, Customer Service Plan Type: 1876 Cost Name: Heather Lacy

Contract Effective Date: 01/01/1987 Phone: 1-800-447-8386 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: New York Fax: Enrollment: 261 Email: [email protected]

Address: 3251 Hollywood Blvd Legal Entity Address: 7 WEST 34TH STREET

City: Hollywood City: NEW YORK State: FL State: NY Zip: 33021 Zip: 10001 Last Updated: 01/09/2015

Legal Entity Name: HEALTH INSURANCE PLAN OF GREATER NEW YORK Contract Number: H3330 Organization Marketing Name: EmblemHealth Medicare HMO Parent Organization:

EmblemHealth, Inc.

Organization Type: Local CCP Contact Title: Director, Customer Service Plan Type: HMO/HMOPOS Name: Heather Lacy

Contract Effective Date: 07/01/1987 Phone: 1-800-447-8386 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: New York Fax: Enrollment: 114,563 Email: [email protected]

Address: 3251 Hollywood Blvd Legal Entity Address: 55 Water Street

City: Hollywood City: NEW YORK State: FL State: NY Zip: 33021 Zip: 10041 Last Updated: 01/09/2015

Legal Entity Name: HEALTH NET COMMUNITY

SOLUTIONS, INC. Contract Number: H3237 Organization Marketing Name: Health Net Cal MediConnect Medicare

Medicaid Plan Parent Organization: Health Net, Inc.

Organization Type: Demo Contact Title: Provider and Provider Directory Information Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Member Services



Address: P.O. Box 10198 Legal Entity Address: 11971 Foundation Place

City: Van Nuys City: Rancho Cordova State: CA


Legal Entity Name: HEALTH NET HEALTH PLAN OF

OREGON Contract Number: H6815 Organization Marketing Name: Health Net Health Plan of Oregon, Inc.

Parent Organization: Health Net, Inc.

Organization Type: Local CCP Contact Title: Provider and Provider Directory Information Plan Type: HMO/HMOPOS Name: Member Services


CMS Region Responsible: Seattle Fax: Enrollment: 24,674 Email: [email protected]

Address: 13221 SW 68th Parkway Legal Entity Address: 13221 SW 68th Parkway, Ste 200

City: Tigard City: Tigard State: OR



Legal Entity Name: HEALTH NET LIFE INSURANCE

COMPANY Contract Number: H5439 Organization Marketing Name: Health Net Life Insurance

Company Parent Organization: Health Net, Inc.

Organization Type: Local CCP Contact Title: Provider and Provider Directory Information Plan Type: Local PPO Name: Member Services



Address: P.O. Box 10198 Legal Entity Address: 21281 BURBANK BLVD.

Building B City: Van Nuys City: WOODLAND HILLS State: CA


Legal Entity Name: HEALTH NET LIFE INSURANCE

COMPANY Contract Number: H5520 Organization Marketing Name: Health Net Life Insurance

Company Parent Organization: Health Net, Inc.

Organization Type: Local CCP Contact Title: Provider and Provider Directory Information Plan Type: Local PPO Name: Member Services



Address: 13221 SW 68th Parkway Legal Entity Address: 13221 SW 68th Parkway, Ste.

200 City: Tigard City: Tigard State: OR


Legal Entity Name: HEALTH NET OF ARIZONA, INC.

Contract Number: H0351 Organization Marketing Name: Health Net of Arizona, Inc.


Organization Type: Local CCP Contact Title: Provider and Provider Directory Information Plan Type: HMO/HMOPOS Name: Member Services


CMS Region Responsible: Seattle Fax: Enrollment: 38,528 Email: [email protected] Address:

1230 W. Washington St., Ste. 401 Legal Entity Address: 1230 W. Washington St.

Suite 401 City: Tempe City: Tempe State: AZ

State: AZ Zip: 85281-2145 Zip: 852812145 Last Updated: 08/23/2006

Legal Entity Name: HEALTH NET OF

CALIFORNIA,INC. Contract Number: H0562 Organization Marketing Name: Health Net of California






Legal Entity Address: 21281 BURBANK BLVD. BUILDING B

City: WOODLAND HILLS State: CA Zip:

91367

Contact Title: Provider and Provider Directory Information Name: Member Services Phone: 1-800-275-4737



City: Van Nuys State: CA

Zip: 91410-0198 Last Updated: 08/21/2006

Legal Entity Name: HEALTH NEW ENGLAND, INC.

Contract Number: H8578 Organization Marketing Name: HNE Medicare Advantage

Plans Parent Organization: Baystate Health, Inc.

Organization Type: Local CCP Contact Title: Director of Government Programs Plan Type: HMO/HMOPOS Name: Susan O'Connor


CMS Region Responsible: Boston Fax: 1-413-233-3352 Enrollment: 8,683 Email: [email protected] Address:

Health New England, Inc. Legal Entity Address: One Monarch Place One Monarch Place, Suite 1500

Suite 1500 City: Springfield City: Springfield State: MA


Legal Entity Name: HEALTH OPTIONS, INC. Contract Number: H1026

Organization Marketing Name: Florida Blue HMO Parent Organization: Guidewell Mutual Holding

Corporation

Organization Type: Local CCP Contact Title: Senior Director Gvn Programs & Product

Compliance Plan Type: HMO/HMOPOS Name: Brendan Hodges



Address: 4800 Deerwood Campus Parkway Legal Entity Address: 4800 Deerwood Campus

Parkway DCC Building 100, 7th Floor

Building 100 / 8th Floor City: Jacksonville City: Jacksonville State: FL


Legal Entity Name: HEALTH PARTNERS PLANS,

INC. Contract Number: H9207 Organization Marketing Name: Health Partners Medicare

Parent Organization: Health Partners Plans, Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: HPP Medicare


CMS Region Responsible: Philadelphia Fax: Enrollment: 13,471 Email: [email protected]

Address: 901 Market Street


Legal Entity Address: 901 Market St Suite 500 Suite 500 City: Philadelphia

City: Philadelphia State: PA State: PA Zip: 19107

Zip: 19107 Last Updated: 04/14/2015 Legal Entity Name: HEALTH PLAN OF

CAREOREGON, INC. Contract Number: H5859 Organization Marketing Name: CareOregon Advantage

Parent Organization: CareOregon, Inc.




Legal Entity Address: 315 SW Fifth Ave. Suite 900

City: Portland State: OR

Zip: 97204

Contact Title: Member Services Supervisor Name: David Lima Phone: 1-800-224-4840


Email: [email protected] Address: CareOregon Advantage

315 SW Fifth Avenue, Suite

900 City: Portland State: OR


Legal Entity Name: HEALTH PLAN OF NEVADA, INC.

Contract Number: H2931 Organization Marketing Name: Health Plan of Nevada, Inc.


Organization Type: Local CCP Contact Title: Director, Government Programs/Member Services Plan Type: HMO/HMOPOS Name: David Stuczynski



Address: 2720 N. Tenaya Way Legal Entity Address: 2720 NORTH TENAYA WAY

P.O. BOX 15645 City: Las Vegas City: LAS VEGAS State: NV

State: NV Zip: 89128 Zip: 891145645 Last Updated: 06/09/2009

Legal Entity Name: HEALTH PLAN OF THE UPPER

OHIO VALLEY Contract Number: H3672 Organization Marketing Name: The Health Plan

Parent Organization: Health Plan of the Upper Ohio

Valley

Organization Type: Local CCP Contact Title: Director Member Services Plan Type: HMO/HMOPOS Name: Sherry Stanley



Address: The Health Plan Legal Entity Address: 52160 National Road East 52160 National Road East

City: St. Clairsville City: St. Clairsville State: OH


Legal Entity Name: HEALTHAMERICA

PENNSYLVANIA, INC. Contract Number: H3959 Organization Marketing Name: HealthAmerica






Address: 151 Farmington Avenue Legal Entity Address: 11 Stanwix Street

City: Hartford City: Pittsburgh State: CT


Legal Entity Name: HEALTHASSURANCE

PENNSYLVANIA, INC. Contract Number: H5522 Organization Marketing Name: HealthAmerica







Legal Entity Address: 11 Stanwix Street

City: Pittsburgh State: PA

Zip: 15222

Contact Title: Name: Aetna Customer Service Phone: 1-800-290-





Legal Entity Name: HEALTHKEEPERS, INC. Contract Number: H0147

Organization Marketing Name: Anthem

HealthKeepers Parent Organization:

Anthem Inc.

Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Customer Service



Address: 145 S. Pioneer Road Legal Entity Address: 2015 Staples Mill Road

City: Fon du Lac City: Richmond State: WI


Legal Entity Name: HEALTHKEEPERS, INC. Contract Number: H3447

Organization Marketing Name: Anthem

HealthKeepers Parent Organization:

Anthem Inc.






Legal Entity Address: 2015 Staples Mill Road City: Fon du Lac

City: Richmond State: WI State: VA Zip: 54935

Zip: 23230 Last Updated: 04/05/2013 Legal Entity Name: HEALTHNOW NEW YORK INC.

Contract Number: H3384 Organization Marketing Name: BCBS of WNY/BS of NENY/HealthNow

New York Inc. Parent Organization: HealthNow New York Inc.




Address: PO Box 13599 Legal Entity Address: 257 West Genesee Street

City: Albany City: BUFFALO State: NY


Legal Entity Name: HEALTHNOW NEW YORK INC.

Contract Number: H5526 Organization Marketing Name: BCBS of WNY/BS of NENY/HealthNow

New York Inc. Parent Organization: HealthNow New York Inc.



Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: New York

Enrollment: 19,206

Legal Entity Address: 257 West Genesee Street

City: Buffalo State: NY Zip:

14202




City: Albany State: NY


Legal Entity Name: HEALTHPARTNERS, INC.

Contract Number: H2422 Organization Marketing Name: HealthPartners

Parent Organization: HealthPartners, Inc.




Legal Entity Address: 8170 33rd AVENUE

SOUTH P.O. Box 1309

City: Minneapolis State: MN

Zip: 55425

Contact Title: Name: Provider Services Phone: 1-952-883-7699

Extension: Fax: Email:

[email protected]

Address: 8170 33rd Avenue South, PO Box 1309

City: Minneapolis State:

MN Zip: 55440-1309



Legal Entity Name: HEALTHPLUS OF

MICHIGAN Contract Number: H2354 Organization Marketing Name: HealthPlus of Michigan

Parent Organization: HealthPlus of Michigan




Legal Entity Address: 2050 S. Linden Road P.O. BOX 1700

City: FLINT State: MI

Zip: 485011700




Address: 2050 S. Linden Road

City: Flint State: MI


Legal Entity Name: HEALTHSPAN

INTEGRATED CARE Contract Number:

H6298 Organization Marketing Name: HealthSpan

Parent Organization: Catholic Health Partners




Legal Entity Address: 1001 Lakeside Ave Suite 1200

City: Cleveland State: OH

Zip: 44114

Contact Title: Manager, Medicare Marketing Name: Aaron Morrow Phone: 1-216-479-


Address: North Point Tower, Suite 1200 1001 Lakeside Avenue


Zip: 44114-1153 Last Updated: 02/13/2014

Legal Entity Name: HEALTHSPAN

INTEGRATED CARE Contract Number:

H6360 Organization Marketing Name: HealthSpan

Parent Organization: Catholic Health Partners




Legal Entity Address: North Point Tower, Suite

1200 1001 Lakeside Avenue

City: CLEVELAND State: OH

Zip: 441141153

Contact Title: Manager, Medicare Marketing Name: Aaron Morrow Phone: 1-216-479-


Address: North Point Tower, Suite 1200 1001 Lakeside Avenue


Zip: 44114-1153 Last Updated: 11/15/2013

Legal Entity Name: HEALTHSPRING LIFE & HEALTH INSURANCE

COMPANY, INC. Contract Number: H2165 Organization Marketing Name: Cigna-


CIGNA




Extension: CMS Region Responsible: Dallas Fax: Enrollment: 6,387 Email: [email protected]

Address: PO Box 20002 Legal Entity Address: 2900 NORTH LOOP WEST

SUITE 1300 City: Nashville City: HOUSTON State: TN State: TX Zip: 37202 Zip: 77092 Last Updated: 02/06/2015




CIGNA Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Wendy Wetzel


Extension: CMS Region Responsible: Dallas Fax: Enrollment: 367 Email: [email protected]

Address: PO Box 20002 Legal Entity Address: 2900 North Loop West

Suite 1300 City: Nashville City: Houston State: TN State: TX Zip: 37202 Zip: 77092 Last Updated: 02/06/2015




CIGNA Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Wendy Wetzel



Address: PO Box 20002 Legal Entity Address: 2900 NORTH LOOP WEST

Suite 1300 City: Nashville City: HOUSTON State: TN State: TX Zip: 37202 Zip: 77092 Last Updated: 02/06/2015




CIGNA





Address: PO Box 20002 Legal Entity Address: 2900 N Loop West


Legal Entity Name: HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. Contract

Number: H6972 Organization Marketing Name: Cigna-HealthSpring Parent

Organization: CIGNA Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Wendy Wetzel


Address: PO Box 20002 Legal Entity Address: 2900 North loop West



Number: H7787 Organization Marketing Name: Cigna-HealthSpring Parent

Organization: CIGNA Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Wendy Wetzel


Address: PO Box 20002 Legal Entity Address: 2900 North Loop West



Number: H8423 Organization Marketing Name: Cigna-HealthSpring CarePlan Parent

Organization: CIGNA


Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Wendy Wetzel


Address: PO Box 20002 Legal Entity Address: 2900 N Loop West


Legal Entity Name: HEALTHSPRING OF

ALABAMA, INC. Contract Number: H0150 Organization Marketing Name: Cigna-


CIGNA




Legal Entity Address: 2 Chase Corporate Drive Ste 300

City: Hoover State: AL

Zip: 35244

Contact Title: Name: Wendy Wetzel Phone: 1-800-668-





Legal Entity Name: HEALTHSPRING OF FLORIDA

Contract Number: H5410 Organization Marketing Name: HealthSpring of Florida, Inc.





Address: PO Box 20002 Legal Entity Address: 8600 NW 41st Street

Suite 201 City: Nashville City: DORAL State: TN



TENNESSEE, INC. Contract Number: H1415 Organization Marketing Name: Cigna-


CIGNA




Address: PO Box 20002 Legal Entity Address: 9701 W Higgins Road

SUITE 360 City: Nashville


City: Rosemont State: TN State: IL Zip: 37202

Zip: 60018 Last Updated: 02/06/2015 Legal Entity Name: HEALTHSPRING OF



CIGNA




Address: PO Box 20002 Legal Entity Address: 530 Great Circle Road

City: Nashville City: Nashville State: TN





CIGNA




Legal Entity Address: 530 Great Circle Road


Zip: 37228

Contact Title: Name: Wendy Wetzel Phone: 1-800-668-







HealthSpring Parent Organization: CIGNA


HMO/HMOPOS Name: Wendy Wetzel



Address: PO Box 20002 Legal Entity Address: 9701 West Higgins Road

Suite 360 City: Nashville City: Rosemont State: TN


Legal Entity Name: HEALTHSUN HEALTH PLANS,

INC. Contract Number: H5431 Organization Marketing Name: HealthSun Health Plans, Inc.

Parent Organization: HealthSun Health Plans, Inc

Organization Type: Local CCP Contact Title: Sr. Vice President Operations and BI


Plan Type: HMO/HMOPOS Name: Scott Griesemer Contract Effective Date: 08/01/2005 Phone: 1-305-234-9292

Tax Status: For Profit Extension: 215 CMS Region Responsible: Atlanta Fax: 1-305-444-9148

Enrollment: 29,847 Email: [email protected] Address: 3250 Mary Street, Suite 500

Legal Entity Address: 3250 Mary Street, Suite 400 City: Coconut Grove

City: Coconut Grove State: FL State: FL Zip: 33133

Zip: 33133 Last Updated: 03/02/2015 Legal Entity Name: HEARTLANDPLAINS HEALTH

Contract Number: H3765 Organization Marketing Name: HeartlandPlains Health

Parent Organization: Catholic Health Initiatives



CMS Region Responsible: Denver Fax: 1-253-779-8829 Enrollment: 512 Email: [email protected] Address:

32129 Weyerhaeuser Way S., Suite 201 Legal Entity Address: 7261 Mercy Rd

City: Federal Way City: Omaha State: WA


Legal Entity Name: HIGHMARK SENIOR HEALTH

COMPANY Contract Number: H3916 Organization Marketing Name: Highmark Senior Health

Company Parent Organization: Highmark Health




Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: Philadelphia

Enrollment: 173,937

Legal Entity Address: 120 FIFTH AVENUE

City: PITTSBURGH State: PA

Zip: 15222

Contact Title: VP, Sr. Markets Operations Name: Sally Rich Phone: 1-866-517-


Address: 120 Fifth Avenue Suite P5501



Legal Entity Name: HIGHMARK SENIOR SOLUTIONS

COMPANY Contract Number: H5106 Organization Marketing Name: Highmark Senior Solutions Company

Parent Organization: Highmark Health

Organization Type: Local CCP Contact Title: VP, Sr. Markets Operations Plan Type: Local PPO Name: Sally Rich



Address: 120 Fifth Avenue Legal Entity Address: 614 Market Street Suite P5501 City:

Pittsburgh City: Parkersburg State: PA


State: WV Zip: 15222 Zip: 26101 Last Updated: 11/30/2012

Legal Entity Name: HMO MISSOURI, INC. Contract Number: H9886

Organization Marketing Name: Anthem Blue Cross and Blue





Address: 145 S. Pioneer Road Legal Entity Address: 1831 Chestnut Street

City: Fon du Lac City: St. Louis State: WI


Legal Entity Name: HMO PARTNERS, INC. Contract Number: H9699

Organization Marketing Name: Health Advantage Parent Organization: USAble Mutual Insurance Company

Organization Type: Local CCP Contact Title: Manager Medicare Operations Plan Type: HMO/HMOPOS Name: Kathryn Thornhill



Address: 320 W. Capitol, Suite 400 Legal Entity Address: 320 West Capitol



Legal Entity Name: HOMETOWN HEALTH PLAN, INC.

Contract Number: H2906 Organization Marketing Name: Senior Care Plus

Parent Organization: Renown Health

Organization Type: Local CCP Plan Type:

Local PPO Contract Effective Date: 07/01/2005

Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: Seattle

Enrollment: 4,060

Legal Entity Address: 830 HARVARD WAY

City: RENO State: NV Zip: 89502

Contact Title: Senior Care Plus Manager Name: CJ Bawden Phone: 1-775-982-3218 Extension:


Harvard Way

City: Reno State: NV


Legal Entity Name: HOMETOWN HEALTH PLAN, INC.

Contract Number: H2960 Organization Marketing Name: Senior Care Plus

Parent Organization: Renown Health

Organization Type: Local CCP Contact Title: Senior Care Plus Manager Plan Type: HMO/HMOPOS Name: CJ Bawden


CMS Region Responsible: Seattle Fax: 1-775-982-3743


Enrollment: 13,797 Email: [email protected] Address: 830 Harvard Way

Legal Entity Address: 830 Harvard Way City: Reno

City: RENO State: NV State: NV Zip: 89502

Zip: 89502 Last Updated: 05/19/2015 Legal Entity Name: HOPE HOSPICE AND COMMUNITY

SERVICES, INC. Contract Number: H5934 Organization Marketing Name: Hope PACE

Parent Organization: Hope Hospice and Community Services,

Inc.

Organization Type: National PACE Contact Title: Business Analyst Plan Type: National PACE Name: Ron Burris



Address: 9470 HealthPark Circle Legal Entity Address: 9470 HealthPark Circle

City: Ft. Myers City: Fort Myers State: FL


Legal Entity Name: HORIZON HEALTHCARE OF NEW

JERSEY, INC. Contract Number: H3154 Organization Marketing Name: Horizon Blue Cross Blue Shield of New

Jersey Parent Organization: Horizon Healthcare Services, Inc.

Organization Type: Local CCP Contact Title: Manager, Service Operations Plan Type: HMO/HMOPOS Name: Lillian Amabile



Address: 3 Penn Plaza East, PP-12L Legal Entity Address: 3 PENN PLAZA EAST

City: Newark City: NEWARK State: NJ


Legal Entity Name: HORIZON HEALTHCARE OF NEW

JERSEY, INC. Contract Number: H7971 Organization Marketing Name: Horizon Blue Cross Blue Shield of New

Jersey Parent Organization: Horizon Healthcare Services, Inc.




Enrollment: 242

Legal Entity Address: 3 Penn Plaza East

City: Newark State: NJ

Zip: 071052200

Contact Title: Manager, Service Operations Name: Lillian Amabile Phone: 1-800-365-


Address: 3 Penn Plaza East, PP-12L

City: Newark State: NJ



Legal Entity Name: HUMANA BENEFIT PLAN OF

ILLINOIS, INC. Contract Number: H1468 Organization Marketing Name: Humana Benefit Plan of Illinois,

Inc. Parent Organization: Humana Inc.




Address: 101 East Main Street Legal Entity Address: 7915 N. Hale Avenue

Suite D City: Louisville City: Peoria State: KY


Legal Entity Name: HUMANA BENEFIT PLAN OF

ILLINOIS, INC. Contract Number: H5525 Organization Marketing Name: Humana Benefit Plan of Illinois,


Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Pamela Wilson



Address: 101 East Main Street Legal Entity Address: 7915 N. Hale Avenue

Suite D City: Louisville City: Peoria State: KY


Legal Entity Name: HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC. Contract Number: H4141 Organization Marketing Name: Humana Employers Health Plan of Georgia, Inc.



Contract Effective Date: 01/01/2010 Phone: 1-800-448-6262 Tax Status: For Profit Extension: CMS Region Responsible: Kansas City Fax: Enrollment: 37,503 Email: [email protected]

Address: 101 East Main Street Legal Entity Address: 900

Ashwood Parkway Suite 500 City: Louisville City: Atlanta State: KY State: GA Zip: 40202 Zip: 30338 Last Updated: 05/06/2013

Legal Entity Name: HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC. Contract Number: H1951 Organization Marketing Name: Humana Health Benefit Plan of Louisiana, Inc.





Address: 101 East Main Street Legal Entity Address: 1 Galleria Boulevard., Suite 850

City: Louisville City: Metairie State: KY State: LA Zip: 40202 Zip: 70001 Last Updated: 05/07/2013

Legal Entity Name: HUMANA HEALTH COMPANY OF NEW

YORK, INC. Contract Number: H3533 Organization Marketing Name: Humana Health Company of New

York, Inc. Parent Organization: Humana Inc.




Address: 101 East Main Street Legal Entity Address: 845 Third Avenue, 7th Floor

City: Louisville City: New York State: KY


Legal Entity Name: HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. Contract Number: H5415 Organization Marketing Name: Humana Health Insurance Company of Florida, Inc.




Address: 101 East Main Street Legal Entity Address: 3501 SW 160th Avenue

City: Louisville City: Miramar State: KY State: FL Zip: 40202 Zip: 33027 Last Updated: 05/06/2013

Legal Entity Name: HUMANA HEALTH PLAN OF OHIO, INC.

Contract Number: H8953 Organization Marketing Name: Humana Health Plan of Ohio, Inc.





Address: 101 East Main Street Legal Entity Address: 640 Eden Park Drive

City: Louisville City: Cincinnati State: KY



Legal Entity Name: HUMANA HEALTH PLAN, INC. Contract

Number: H0336 Organization Marketing Name: Humana Health Plan, Inc.


Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Pamela Wilson



Address: 101 East Main Street Legal Entity Address: 321 West Main Street

12th Floor City: Louisville City: Louisville State: KY


Legal Entity Name: HUMANA HEALTH

PLAN, INC. Contract Number: H1406 Organization Marketing Name: Humana Health Plan,





Address: 101 East Main Street Legal Entity Address: 321 West Main Street,



























CMS Region Responsible: Kansas City Enrollment: 42,525

Legal Entity Address: 321 West Main Street,

12th Floor


Zip: 40202

Contact Title: Name: Pamela Wilson Phone: 1-800-448-


Address: 101 East Main Street



Legal Entity Name: HUMANA HEALTH PLAN, INC. Contract

Number: H3480 Organization Marketing Name: Humana Health Plan, Inc.


Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Pamela Wilson



Address: 101 East Main Street Legal Entity Address: 321 West Main Street, 12th Floor

City: Louisville City: Louisville State: KY


Legal Entity Name: HUMANA HEALTH PLANS OF PUERTO

RICO, INC. Contract Number: H4007 Organization Marketing Name: HUMANA HEALTH PLANS OF

PUERTO RICO, INC. Parent Organization: Humana Inc.




Address: 101 East Main Street Legal Entity Address: 383 F.D. Roosevelt Avenue, 3rd Floor

City: Louisville City: San Juan State: KY



Legal Entity Name: HUMANA INSURANCE COMPANY

Contract Number: H1418 Organization Marketing Name: Humana Insurance Company Parent

Organization: Humana Inc.




Address: 101 East Main Street Legal Entity Address: 1100 Employers Boulevard

City: Louisville City: DePere State: KY





Organization Type: Local CCP Plan

Type: Local PPO Contract Effective Date:



Legal Entity Address: 1100 Employers Boulevard

City: DePere State: WI

Zip: 54115

Contact Title: Name: Pamela Wilson Phone: 1-800-448-6262

Extension: Fax: Email: [email protected] Address: 101

East Main Street



Legal Entity Name: HUMANA INSURANCE

COMPANY Contract Number: H1716 Organization Marketing Name: Humana Insurance

Company Parent Organization: Humana Inc.




Address: 101 East Main Street Legal Entity Address: 1100 Employers

Boulevard City: Louisville City: DePere State: KY





Organization Type: PFFS Contact Title: Plan Type: PFFS Name: Pamela Wilson




Address: 101 East Main Street Legal Entity Address: 1100 EMPLOYERS

BLVD City: Louisville City: DePERE State: KY








Address: 101 East Main Street Legal Entity Address: 1100 Employers

Boulevard City: Louisville City: DePere State: KY










Legal Entity Address: 1100 EMPLOYERS

BLVD

City: DePERE State: WI

Zip: 54115












Address: 101 East Main Street Legal Entity Address: 1100 Employers Blvd.





Contract Number: R5826 Organization Marketing Name: Humana Insurance Company Parent


Organization Type: Regional CCP Contact Title: Plan Type: Regional PPO Name: Pamela Wilson



Address: 101 East Main Street Legal Entity Address: 1100 Employers Boulevard



Legal Entity Name: HUMANA INSURANCE COMPANY OF

NEW YORK Contract Number: H1291 Organization Marketing Name: Humana Insurance Company of

New York Parent Organization: Humana Inc.



CMS Region Responsible: Kansas City Fax: Enrollment: 306 Email: [email protected]

Address: 101 East Main Street Legal Entity Address: 845 Third Avenue

7th Floor City: Louisville City: New York State: KY


Legal Entity Name: HUMANA INSURANCE COMPANY OF

NEW YORK Contract Number: H5970 Organization Marketing Name: Humana Insurance Company of

New York Parent Organization: Humana Inc.






Legal Entity Address: 845 Third Avenue 7th Floor


Zip:

10022






Legal Entity Name: HUMANA INSURANCE OF PUERTO

RICO, INC. Contract Number: H2029 Organization Marketing Name: Humana Insurance of Puerto Rico, Inc.




CMS Region Responsible: Kansas City Fax:


Enrollment: 1,772 Email: [email protected] Address: 101 East Main Street

Legal Entity Address: 383 F.D. Roosevelt Avenue 3rd Floor City: Louisville

City: San Juan State: KY State: PR Zip: 40202

Zip: 00918 Last Updated: 05/06/2013 Legal Entity Name: HUMANA MEDICAL PLAN OF

MICHIGAN, INC. Contract Number: H8908 Organization Marketing Name: Humana Medical Plan of Michigan, Inc.





Address: 101 East Main Street Legal Entity Address: 5555 Glenwood Hills Pkwy

Suite 150 City: Louisville City: Grand Rapids State: KY


Legal Entity Name: HUMANA MEDICAL PLAN OF

PENNSYLVANIA, INC. Contract Number: H6859 Organization Marketing Name: Humana Medical Plan of Pennsylvania,





Address: 101 East Main Street Legal Entity Address: 5000 Ritter Rd

Suite 101 City: Louisville City: Mechanicsburg State: KY


Legal Entity Name: HUMANA MEDICAL PLAN OF UTAH, INC.

Contract Number: H2486 Organization Marketing Name: Humana Medical Plan of Utah, Inc.





Legal Entity Address: 9815 South Monroe Street Suite 300

City: Sandy State: UT

Zip: 84070

Contact Title: Name: Pamela Wilson Phone: 1-800-448-6262


101 East Main Street




Legal Entity Name: HUMANA MEDICAL PLAN, INC.

Contract Number: H1036 Organization Marketing Name: Humana Medical Plan, Inc.





Address: 101 East Main Street Legal Entity Address: 3501 SW 160th Avenue

City: Louisville City: Miramar State: KY


Legal Entity Name: HUMANA REGIONAL HEALTH PLAN,

INC. Contract Number: H4145 Organization Marketing Name: Humana Regional Health Plan, Inc.





Address: 101 East Main Street Legal Entity Address: 300 Spring Building, Suite 900

300 S Spring Street City: Louisville City: Little Rock State: KY


Legal Entity Name: HUMANA WI HEALTH ORGANIZATION INSURANCE CORP Contract Number: H6622 Organization Marketing Name: Humana WI Health Organization Insurance Corp Parent Organization:

Humana Inc.



Address: 101 East Main Street Legal Entity Address: Two Riverwood Place

N19W24133 Riverwood Drive, Suite 300 City: Louisville City: Waukesha State: KY State: WI Zip: 40202 Zip: 531881145 Last Updated: 05/06/2013

Legal Entity Name: HUMBOLDT SENIOR RESOURCE

CENTER, INC. Contract Number: H3517 Organization Marketing Name: Redwood Coast PACE

Parent Organization: Humboldt Senior Resource Center,

Inc.





Legal Entity Address: 1910 California Street

City: Eureka State: CA

Zip:

95501

Contact Title: Director of Communication and

Marketing Name: Rene Arche Phone: 1-707-443-9747

Extension: 1256


Address: 1910 California Street

City: Eureka State: CA


Legal Entity Name: IEHP HEALTH ACCESS Contract Number: H5355

Organization Marketing Name: IEHP DualChoice Parent Organization: INLAND EMPIRE HEALTH PLAN

Organization Type: Demo Contact Title: Member Services Plan Type: Medicare-Medicaid Plan




Address: 10801 Sixth Street, Suite #120 Legal Entity Address: 10801 Sixth Street, Suite #120

City: Rancho Cucamonga City: Rancho Cucamonga State: CA


Legal Entity Name: ILLINICARE HEALTH PLAN

Contract Number: H0281 Organization Marketing Name: IlliniCare Health






Address: 999 Oakmont Plaza Drive Legal Entity Address: 999 Oakmont Plaza Drive

City: Westmont City: Westmont State: IL


Legal Entity Name: INDEPENDENCE CARE

SYSTEM, INC. Contract Number: H4465 Organization Marketing Name: ICS Community Care Plus

FIDA MMP Parent Organization: Paraprofessional Healthcare

Institute

Organization Type: Demo Contact Title: VP, Communications/Community Relations Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Loreen Loonie


CMS Region Responsible: New York Fax: 1-212-584-2555


Enrollment: 333 Email: [email protected]

Address: 257 Park Avenue South Legal Entity Address: 257 Park Avenue South

2nd Floor City: New York City: New York State: NY


Legal Entity Name: INDEPENDENT CARE HEALTH

PLAN, INC. Contract Number: H2237 Organization Marketing Name: iCare

Parent Organization: Independent Care Health Plan

Inc.




Legal Entity Address: 1555 North River Center Drive Suite 206

City: Milwaukee State: WI

Zip: 53212



Address: 1555 N Rivercenter Drive Suite 206

City: Milwaukee State: WI


Legal Entity Name: INDEPENDENT HEALTH ASSOCIATION,

INC. Contract Number: H3362 Organization Marketing Name: Independent Health

Parent Organization: Independent Health Association, Inc.




Address: 511 Farber Lakes Drive Legal Entity Address: 511 FARBER LAKES DRIVE

City: Buffalo City: BUFFALO State: NY


Legal Entity Name: INDEPENDENT HEALTH BENEFITS

CORPORATION Contract Number: H3344 Organization Marketing Name: Independent Health

Parent Organization: Independent Health Association, Inc.

Organization Type: Local CCP Contact Title: Plan Type: Local PPO Name: Member Services



Address: 511 Farber Lakes Drive Legal Entity Address: 511 FARBER LAKES DRIVE

City: Buffalo City: BUFFALO State: NY



Legal Entity Name: INDEPENDENT LIVING FOR SENIORS,

INC. Contract Number: H3331 Organization Marketing Name: ElderONE an Affiliate of Rochester

Regional Health Parent Organization: Rochester General

Health System

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Jill Graziano



Address: 490 E. Ridge Road Legal Entity Address: 2066 HUDSON AVENUE

City: Rochester City: ROCHESTER State: NY


Legal Entity Name: INDEPENDENT LIVING SRVCS OF

CENTRAL NY Contract Number: H3321 Organization Marketing Name: Independent Living Srvcs Of Central

Ny Parent Organization: Loretto Rest Realty Corporation




Legal Entity Address: 100 MALTA LANE

City: NORTH SYRACUSE State: NY Zip:

13212

Contact Title: Name: Ginny Turley Phone: 1-315-452-5800

Extension: 156


Address: 100 Malta Lane

City: North Syracuse State: NY


Legal Entity Name: INDIANA UNIVERSITY HEALTH PLANS,

INC. Contract Number: H7220 Organization Marketing Name: Indiana University Health Plans -

Medicare Parent Organization: Indiana University Health

Organization Type: Local CCP Contact Title: Director, Customer Solutions Center Plan Type: HMO/HMOPOS Name: Trina Gibson



Address: 950 N. Meridian Street Legal Entity Address: 950 N. Meridian Street, Suite 200 Suite 200 City:

Indianapolis City: Indianapolis State: IN


Legal Entity Name: INOVACARES Contract Number: H6310

Organization Marketing Name: InovaCares for Seniors Parent Organization: Inova Health Systems, Inc.

Organization Type: National PACE Contact Title: Program Director Plan Type: National PACE Name: Elissa Clark


CMS Region Responsible: Philadelphia Fax: 1-703-323-0331


Enrollment: 97 Email: [email protected] Address: 9900 Main Street

Legal Entity Address: 4027B Olley Lane City: Fairfax

City: Fairfax State: VA State: VA Zip: 22031

Zip: 22032 Last Updated: 12/29/2014 Legal Entity Name: INSURANCE COMPANY OF SCOTT AND

WHITE Contract Number: H8237 Organization Marketing Name: Vital Traditions

Parent Organization: Baylor Scott & White Holdings

Organization Type: Local CCP Contact Title: Call Center Plan Type: HMO/HMOPOS Name: Customer Service



Address: 1206 West Campus Drive Legal Entity Address: 1206 West Campus Dr

City: Temple City: Temple State: TX


Legal Entity Name: INTER VALLEY HEALTH PLAN, INC.

Contract Number: H0545 Organization Marketing Name: Inter Valley Health Plan

Parent Organization: InterValley Health Plan




Legal Entity Address: 300 SOUTH PARK PO BOX 6002

City: POMONA State: CA

Zip: 917696002

Contact Title: Manager, Enrollment & Reimbursement Name: Kim

Porter Phone: 1-800-251-8191

Extension: 426 Fax: Email: [email protected] Address: 300 S.

Park Ave.

City: Pomona State: CA


Legal Entity Name: ITASCA MEDICAL CARE Contract Number: H2417

Organization Marketing Name: Itasca Medical Care/IMCare

Classic Parent Organization: Itasca County Health & Human

Services

Organization Type: Local CCP Contact Title: Program Director Plan Type: HMO/HMOPOS Name: Brett Skyles



Address: 1219 SE 2nd Ave. Legal Entity Address: 1219 SE 2ND AVENUE

City: Grand Rapids City: GRAND RAPIDS State: MN

State: MN Zip: 55744 Zip: 55744 Last Updated: 05/15/2007


Legal Entity Name: KAISER FNDN HP OF THE MID-

ATLANTIC STS Contract Number: H2150 Organization Marketing Name: Kaiser Permanente

Parent Organization: Kaiser Foundation Health Plan, Inc.

Organization Type: 1876 Cost Contact Title: Director of Account Experience & Customer

Engagemt Plan Type: 1876 Cost Name: Kennith Bailey



Address: 2101 East Jefferson Street Legal Entity Address: 2101 EAST JEFFERSON ST

City: Rockville City: ROCKVILLE State: MD

State: MD Zip: 20852 Zip: 20852 Last Updated: 04/01/2013

Legal Entity Name: KAISER FOUNDATION HP OF CO

Contract Number: H0630 Organization Marketing Name: Kaiser Permanente




CMS Region Responsible: San Francisco Fax: 1-303-338-3444 Enrollment: 98,064 Email: [email protected] Address:

2500 S. Havana St. Legal Entity Address: 10350 E Dakota Avenue

PO Box 378066 City: Aurora City: Denver State: CO


Legal Entity Name: KAISER FOUNDATION HP OF GA,

INC. Contract Number: H1170 Organization Marketing Name: Kaiser Permanente





Legal Entity Address: 3495 PIEDMONT ROAD BUILDING 9

City: ATLANTA State: GA

Zip: 30305

Contact Title: Name: Member Services Phone: 1-NAExtension:


Address: 3495 Piedmont Road NE Ten Piedmont Center

City: Atlanta State: GA


Legal Entity Name: KAISER FOUNDATION HP OF

THE N W Contract Number: H9003 Organization Marketing Name: Kaiser Permanente

Parent Organization: Kaiser Foundation Health

Plan, Inc.





Address: 500 NE Multnomah St.,Suite

100 Legal Entity Address: 500 NE Multnomah St



Legal Entity Name: KAISER FOUNDATION HP,



Plan, Inc.



CMS Region Responsible: San Francisco Fax: Enrollment: 1,032,671 Email: [email protected]

Address: 10740 Fourth St., Second Floor Legal Entity Address: P.O. BOX 12916

City: Rancho Cucamonga City: OAKLAND State: CA





Plan, Inc.

Organization Type: Local CCP Contact Title: Medicare Compliance Consultant Plan Type: HMO/HMOPOS Name: Shawn Ripley



Address: 1 Kaiser Plaza Legal Entity Address: 711 KAPIOLANI BLVD Floor 13 City:

Oakland City: HONOLULU State: CA

State: HI Zip: 94612 Zip: 96813 Last Updated: 10/27/2014



Medicare Cost Parent Organization: Kaiser Foundation Health

Plan, Inc.




Legal Entity Address: P.O.BOX 12916

City: OAKLAND State: CA

Contact Title: Name: Member Services Phone: 1-800-443-0815


Address: 10740 Fourth St., Second Floor

City: Rancho Cucamonga State: CA



Zip: 946042916

Legal Entity Name: KAISER FOUNDATION HP, INC.

Contract Number: H6052 Organization Marketing Name: Kaiser Permanente Medicare

Cost Parent Organization: Kaiser Foundation Health Plan,

Inc.

Organization Type: 1876 Cost Contact Title: Plan Type: 1876 Cost Name: Member Services



Address: 10740 Fourth St., Second Floor Legal Entity Address: P.O. BOX 12916

City: Rancho Cucamonga City: OAKLAND State: CA


Legal Entity Name: KEYSTONE HEALTH PLAN

CENTRAL, INC. Contract Number: H3962 Organization Marketing Name: Keystone Health Plan

Central, Inc. Parent Organization: Capital BlueCross

Organization Type: Local CCP Contact Title: Customer Service Manager Plan Type: HMO/HMOPOS Name: Barbara Keffer



Address: 2500 Elmerton Avenue Legal Entity Address: P.O. Box 779827 P.O. Box 774135

City: Harrisburg City: HARRISBURG State: PA


Legal Entity Name: KEYSTONE HEALTH PLAN

EAST, INC. Contract Number: H3952 Organization Marketing Name: Keystone 65 HMO

Parent Organization: Independence Health Group, Inc.




Address: PO Box 7799 Legal Entity Address: 1901 MARKET ST

45TH FLOOR City: Philadelphia


City: PHILADELPHIA State: PA State: PA Zip: 19101-7799

Zip: 19103 Last Updated: 04/29/2015 Legal Entity Name: KEYSTONE HEALTH PLAN

WEST, INC. Contract Number: H3957 Organization Marketing Name: Highmark Choice

Company Parent Organization: Highmark Health




Legal Entity Address: 120 FIFTH

AVE


Zip: 152223099

Contact Title: VP, Sr. Markets Operations Name: Sally Rich Phone: 1-866-517-


Address: 120 Fifth Avenue Suite P5501



Legal Entity Name: KISSITO PACE OF

ROANOKE, INC. Contract Number: H1239 Organization Marketing Name: Kissito PACE

Marketing Parent Organization: Kissito

Healthcare, Inc.

Organization Type: National PACE Contact Title: VP Business Development Plan Type: National PACE Name: Josh McGilliard



Address: 5251 Concourse Drive Legal Entity Address: 5251 Concourse Drive

City: Roanoke City: Roanoke State: VA


Legal Entity Name: KS PLAN

ADMINISTRATORS, LLC Contract Number:

H0332 Organization Marketing Name: KelseyCare Advantage

Parent Organization: Kelsey-Seybold Medical

Group, PLLC

Organization Type: Local CCP Contact Title: Director, Quality & Compliance Plan Type: HMO/HMOPOS Name: Margaret A Drakeley


CMS Region Responsible: Dallas Fax: 1-713-442-5212 Enrollment: 29,804 Email:

[email protected] Address: 11511 Shadow Creek Parkway

Legal Entity Address: 2727 West Holcombe 4th Floor, Admin City: Pearland

City: Houston State: TX State: TX Zip: 77584



Legal Entity Name: LIBERTY HEALTH

ADVANTAGE, INC. Contract Number: H3337 Organization Marketing Name: Liberty Health Advantage

Parent Organization: Liberty Health Advantage,

Inc.




Address: One Huntington

Quadrangle Legal Entity Address: 1 Huntington Quadrangle,

Suite 3N01 Suite 3N01

City: Melville City: Melville State: NY


Legal Entity Name: LIFE AT LOURDES, INC. Contract Number: H3493

Organization Marketing Name: LIFE at Lourdes Parent Organization: Trinity Health




Legal Entity Address: 2475 McClellan Ave., Bldg C Building C

City: Pennsauken State: NJ

Zip: 08109

Contact Title: Executive Director Name:

Marge Sullivan Phone: 1-856-675-3663 Extension:


Address: 2475 McClellan Avenue Building C

City: Pennsauken State: NJ


Legal Entity Name: LIFE AT ST. FRANCIS HEALTHCARE, INC.

Contract Number: H5493 Organization Marketing Name: St. Francis LIFE

Parent Organization: Trinity Health

Organization Type: National PACE Contact Title: Administrator Plan Type: National PACE Name: Amy Milligan



Address: 1072 Justison Street Legal Entity Address: 1072 Justison Street

City: Wilmington City: Wilmington State: DE

State: DE Zip: 19801 Zip: 19801 Last Updated: 03/18/2013

Legal Entity Name: LIFE PACE Contract Number: H6941

Organization Marketing Name: LIFE PACE, INC. Parent Organization: LIFE Senior Services, Inc.

Organization Type: National PACE Contact Title: Program Director Plan Type: National PACE Name: Brian McKaig



CMS Region Responsible: Dallas Fax: Enrollment: * Email: [email protected]

Address: 5950 East 31st Street Legal Entity Address: 5950 E. 31st Street

City: Tulsa City: Tulsa State: OK


Legal Entity Name: LIFE ST. FRANCIS Contract Number: H1234

Organization Marketing Name: LIFE St. Francis Parent Organization:

Trinity Health

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Jill Ann Viggiano


CMS Region Responsible: New York Fax: 1-609-695-4234 Enrollment: 278 Email: [email protected] Address: 1435 Liberty St.

Legal Entity Address: 1435 Liberty St. City: Hamilton

City: Hamilton State: NJ State: NJ Zip: 08629

Zip: 08629 Last Updated: 05/02/2015 Legal Entity Name: LIFE ST. JOSEPH OF THE PINES, INC.

Contract Number: H1500 Organization Marketing Name: LIFE St. Joseph of the Pines Parent

Organization: St Joseph of the Pines, Inc.




Legal Entity Address: 4900 Raeford Rd

City: Fayetteville State: NC

Zip: 28304

Contact Title: Executive Director Name: Robert

L Dickson Phone: 1-910-429-7255 Extension:


Address: 4900 Raeford Road

City: Fayetteville State: NC


Legal Entity Name: LIFE ST. MARY, INC. Contract Number: H6551

Organization Marketing Name: LIFE St. Mary Parent Organization: St. Mary Medical Center



CMS Region Responsible: Philadelphia Enrollment: 218

Legal Entity Address: 2500 Northgate Drive

City: Trevose State: PA

Zip: 19053

Contact Title: Finance Director Name: Jennifer

White Phone: 1-267-991-7625 Extension:


Northgate Road

City: Trevose State: PA



Legal Entity Name: LIFECIRCLES Contract Number:

H2936 Organization Marketing Name: LIFECIRCLES Parent

Organization: LifeCircles




Legal Entity Address: 560 Seminole Rd.

City: Muskegon State: MI

Zip: 49444

Contact Title: Executive Director Name: Luke

Reynolds Phone: 1-231-733-8650 Extension:


Seminole Rd.

City: Muskegon State: MI


Legal Entity Name: LIVING INDEPENDENCE FOR THE

ELDERLY Contract Number: H3918 Organization Marketing Name: LIFE Pittsburgh

Parent Organization: Living Independence for the Elderly




Legal Entity Address: 681 Andersen Drive Building 6, Floor 5


Zip: 15220

Contact Title: Director of Finance

Name: Laura B Schmitt Phone: 1-412-388-8042


Email: [email protected] Address: 681 Andersen drive

Building 6, Floor 5 City: Pittsburgh

State: PA Zip: 15220

Last Updated: 08/02/2010 Legal Entity Name: LOCAL INITIATIVE HEALTH AUTHORITY FOR L.A. COUNTY Contract

Number: H8258 Organization Marketing Name: L.A. Care Cal MediConnect Plan

Parent Organization: Local Initiative Health Authority for LA County Organization Type: Demo Contact Title: Sr. Director Medicare & CalMediConnect Ops Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Gretchen Brown Contract Effective Date: 04/01/2014 Phone: 1-213-694-1250 Tax Status: Not-for-Profit/Non-Profit Extension: 4805 CMS Region Responsible: San Francisco Fax: 1-213-438-5736 Enrollment: 14,838 Email: [email protected]

Address: 1055 West 7th Street Legal Entity Address: 1055 W. 7th Street 4th Fl

10th Floor City: Los Angeles City: Los Angeles State: CA State: CA Zip: 90017 Zip: 90017 Last Updated: 02/02/2015

Legal Entity Name: LOS ANGELES JEWISH HOME FOR

THE AGING Contract Number: H7855 Organization Marketing Name: Brandman Centers for Senior Care

Parent Organization: Los Angeles Jewish Home for the

Aging

Organization Type: National PACE Contact Title: Marketing Director Plan Type: National PACE Name: Santos Rodriguez




Address: 7150 Tampa Avenue Legal Entity Address: 7150 Tampa Avenue

7150 Tampa Avenue City: Reseda City: Reseda State: CA


Legal Entity Name: LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION Contract Number:

H9998 Organization Marketing Name: Silver Star

Parent Organization: Lubbock Regional Mental Health Organization Type: National PACE Contact Title: CHIEF INFORMATION OFFICER Plan Type: National PACE Name:

Wendy Potitadkul Contract Effective Date: 05/01/2010 Phone: 1-806-766-0272 Tax Status: Not-for-Profit/Non-Profit Extension:


Address: P.O. Box 2828 Legal Entity Address: PO

Box 2828 4010 22nd Street City: Lubbock City: LUBBOCK State: TX


Legal Entity Name: LUTHERAN SENIOR HEALTHCARE,

INC. Contract Number: H6371 Organization Marketing Name: Lutheran Senior LIFE

Parent Organization: Lutheran Social Ministries of New

Jersey

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Wanda Cooper



Address: 377 Jersey Avenue Legal Entity Address: 3 Manhattan Drive Suite 310 City:

Jersey City City: Burlington State: NJ


Legal Entity Name: LUTHERAN SENIORLIFE VIECARE ARMSTRONG, LLC Contract Number:

H6188 Organization Marketing Name: LIFE Armstrong

Parent Organization: Lutheran SeniorLife Organization Type: National PACE Contact Title: Director of MIS Plan Type: National PACE Name: Dean

Phillips Contract Effective Date: 04/01/2015 Phone: 1-724-776-1100 Tax Status: Not-for-Profit/Non-Profit

Extension: CMS Region Responsible: Philadelphia Fax: 1-724-772-2960 Enrollment: 12 Email: [email protected]

Address: Lutheran SeniorLife Legal Entity Address: 1 Nolte Drive 191 Scharberry Lane

City: Mars City: Kittanning State: PA State: PA Zip: 16046 Zip: 16201 Last Updated: 10/06/2014


Legal Entity Name: MANAGED HEALTH SERVICES,

WISCONSIN Contract Number: H8189 Organization Marketing Name: MHS Health Wisconsin

Advantage Parent Organization: Centene

Corporation

Organization Type: Local CCP Contact Title: Sr. VP, Government Relations & Compliance Plan Type: HMO/HMOPOS Name: Sandi Tunis



Address: 10700 West Research

Drive Legal Entity Address: 10700 West Research Drive Suite 300

Suite 300 City: Milwaukee City: Milwaukee State: WI


Legal Entity Name: MANAGED HEALTH, INC. Contract Number: H3359

Organization Marketing Name: Healthfirst Medicare Plan Parent

Organization: Healthfirst, Inc.

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Provider Services


CMS Region Responsible: New York Fax: Enrollment: 128,987 Email: [email protected] Address: P.O.

Box 5168 Legal Entity Address: 100 Church Street, 18th Floor


State: NY Zip: 10274-5168 Zip: 10007 Last Updated: 08/20/2014

Legal Entity Name: MANAGED HEALTH, INC. Contract Number: H5441

Organization Marketing Name: Healthfirst Medicare Plan

Parent Organization: Healthfirst, Inc.


HMO/HMOPOS Name: Provider Services



Address: P.O. Box 5168 Legal Entity Address: 100 Church Street, 18th Floor


State: NY Zip: 10274-5168 Zip: 10007 Last Updated: 08/20/2014

Legal Entity Name: MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT Contract

Number: H6623 Organization Marketing Name: Maricopa Care Advantage

Parent Organization: MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT


Organization Type: Local CCP Contact Title: MCA Customer Care Plan Type: HMO/HMOPOS Name: Customer Care

Contract Effective Date: 01/01/2014 Phone: 1-877-874-3935 Tax Status: For Profit Extension: CMS Region Responsible: San Francisco Fax: 1-520-874-3434 Enrollment: 1,861 Email: [email protected]

Address: 2701 E. Elvira Rd Legal Entity Address: 2601 East Roosevelt St

City: Tucson City: Phoenix State: AZ State: AZ Zip: 85756 Zip: 85008 Last Updated: 08/10/2015

Legal Entity Name: MARTIN'S POINT GENERATIONS,

LLC Contract Number: H1365 Organization Marketing Name: Martin's Point Generations

Advantage Parent Organization: Martin's Point Health

Care, Inc.

Organization Type: Local CCP Contact Title: Chief Operating Officer Plan Type: Local PPO Name: Larry Henry



Address: P. O. Box 9746 Legal Entity Address: PO Box 9746 331 Veranda Street

331 Veranda St. City: Portland City: Portland State: ME


Legal Entity Name: MARTIN'S POINT GENERATIONS,

LLC Contract Number: H5591 Organization Marketing Name: Martin's Point Generations

Advantage Parent Organization: Martin's Point Health

Care, Inc.

Organization Type: Local CCP Contact Title: Chief Operating Officer Plan Type: HMO/HMOPOS Name: Larry Henry



Address: P. O. Box 9746 Legal Entity Address: P.O. Box 9746 331 Veranda Street

331 Veranda Street City: Portland City: Portland State: ME


Legal Entity Name: MATTHEW THORNTON HEALTH

PLAN, INC. Contract Number: H3536 Organization Marketing Name: Anthem Blue Cross and Blue





Address: 145 S. Pioneer Road Legal Entity Address: 3000 Goffs Falls Road

City: Fon du Lac City: Manchester State: WI


State: NH Zip: 54935 Zip: 031110001 Last Updated: 04/05/2013

Legal Entity Name: MCGREGOR PACE Contract Number: H3613

Organization Marketing Name: McGregor PACE Parent Organization: McGregor at Overlook




Legal Entity Address: 26310 Emery Road

City: Warrensville HEIGHTS State: OH

Zip: 44128

Contact Title: CEO Name: Tangi McCoy Phone: 1-216-851-8200

Extension: 2058 Fax: Email: [email protected] Address: 2373

Euclid Heights Blvd.

City: Cleveland Heights State: OH


Legal Entity Name: MCLAREN HEALTH PLAN, INC. Contract

Number: H0141 Organization Marketing Name: McLaren Advantage

Parent Organization: McLaren Health Care Corporation

Organization Type: Local CCP Contact Title: Compliance Officer Plan Type: HMO/HMOPOS Name: Sue Bayer


CMS Region Responsible: Chicago Fax: Enrollment: 126 Email: [email protected] Address: G3245

Beecher Rd Legal Entity Address: G-3245 Beecher Rd.

City: Flint City: Flint State: MI


Legal Entity Name: MCS ADVANTAGE, INC. Contract Number: H5577

Organization Marketing Name: MCS Classicare Parent Organization: Medical Card System, Inc.

Organization Type: Local CCP Contact Title: Corporate Communications Director Plan Type: HMO/HMOPOS Name: Marien Amezaga


CMS Region Responsible: New York Fax: Enrollment: 175,413 Email: [email protected] Address:

MCS Plaza Legal Entity Address: MCS Plaza 255 Ponce de Leon Avenue, Second Floor

255 Ponce De Leon Ave. City: San Juan City: San Juan State: PR


Legal Entity Name: MEDICA HEALTH PLANS Contract Number: H2458

Organization Marketing Name: Medica Health Plans Parent Organization: Medica Holding Company





Address: 401 Carlson Parkway Legal Entity Address: 401 Carlson Parkway

City: Minnetonka City: MINNETONKA State: MN


Legal Entity Name: MEDICA HEALTHCARE PLANS, INC.

Contract Number: H5420 Organization Marketing Name: Medica HealthCare Plans, Inc.





Legal Entity Address: 4000 Ponce de Leon Blvd. Suite 650

City: CORAL GABLES State: FL

Zip: 33146

Contact Title: COO for United for South Florida Name: Annette Onorati Phone: 1-305-670-8438 Extension: 1225


Address: 9100 South Dadeland Blvd Suite 1250

City: Miami State: FL


Legal Entity Name: MEDICA INSURANCE COMPANY

Contract Number: H2450 Organization Marketing Name: Medica Insurance Company

Parent Organization: Medica Holding Company

Organization Type: 1876 Cost Contact Title: Plan Type: 1876 Cost Name: Customer Service



Address: 401 Carlson Parkway Legal Entity Address: 401 Carlson Parkway

P.O. BOX 9310 City: Minnetonka City: MINNEAPOLIS State: MN


Legal Entity Name: MEDICAL ASSOCIATES CLINIC

HEALTH PLAN Contract Number: H5256 Organization Marketing Name: Medical Associates Clinic Health

Plan of Wisconsin Parent Organization: Medical Associates

Clinic, P.C.

Organization Type: 1876 Cost Contact Title: Marketing Specialist Plan Type: 1876 Cost Name: Julie Hoffmann



Address: 1605 Associates Drive Legal Entity Address: 1605 ASSOCIATES DRIVE

City: Dubuque City: DUBUQUE State: IA



Legal Entity Name: MEDICAL ASSOCIATES HEALTH

PLAN, INC. Contract Number: H1651 Organization Marketing Name: Medical Associates Health Plan, Inc.

Parent Organization: Medical Associates Clinic, P.C.

Organization Type: 1876 Cost Contact Title: Marketing Specialist Plan Type: 1876 Cost Name: Julie Hoffmann



Address: 1605 Associates Drive Legal Entity Address: 1605 Associates Drive

City: Dubuque City: DUBUQUE State: IA


Legal Entity Name: MEDISUN, INC.

Contract Number: H0302 Organization Marketing Name: Blue Cross Blue Shield of Arizona

Advantage Parent Organization: Veritage, LLC




Legal Entity Address: 13950 W. Meeker Blvd

City: Sun City West State: AZ

Zip: 85375



Address: 13950 W. Meeker Blvd

City: Sun City West State: AZ


Legal Entity Name: MEDSTAR FAMILY CHOICE, INC.

Contract Number: H9915 Organization Marketing Name: MedStar Family Choice, Inc

Parent Organization: Medstar Health, Inc.

Organization Type: Local CCP Contact Title: AVP Regulatory Affairs, Network Dev and

Marketing Plan Type: HMO/HMOPOS Name: Lesley Wallace



Address: 5233 King Avenue Legal Entity Address: 5233 King Avenue Suite 400

Suite 400 City: Baltimore City: Baltimore State: MD

State: MD Zip: 21237 Zip: 21237 Last Updated: 08/03/2015

Legal Entity Name: MEMORIAL HERMANN HEALTH

PLAN Contract Number: H2968 Organization Marketing Name: Memorial Hermann Health

Insurance Company Parent Organization: Memorial

Hermann Healthcare System

Organization Type: Local CCP Contact Title: Network Development Plan Type: Local PPO Name: Josette Hubbard




Enrollment: 453 Email: [email protected] Address: 929 Gessner #1500

Legal Entity Address: 929 Gessner Suite 1500 City: Houston


Zip: 77024 Last Updated: 02/09/2015 Legal Entity Name: MEMORIAL HERMANN HEALTH

PLAN Contract Number: H7115 Organization Marketing Name: Memorial Hermann Health Plan,

Inc. Parent Organization: Memorial Hermann Healthcare

System

Organization Type: Local CCP Contact Title: Network Development Plan Type: HMO/HMOPOS Name: Josette Hubbard



Address: 929 Gessner #1500 Legal Entity Address: 929 Gessner

Suite 1500 City: Houston City: Houston State: TX


Legal Entity Name: MEMORIAL HOSPITAL OF

LARAMIE COUNTY Contract Number: H4000 Organization Marketing Name: Wyoming PACE

Parent Organization: Memorial Hospital of Laramie

County




Legal Entity Address: 214 East 23rd Street

City: Cheyenne State: WY

Zip: 82001

Contact Title: PACE Director

Name: Laura Wright Phone: 1-307-633-7005



Address: 214 E. 23rd St.

City: Cheyenne State: WY


Legal Entity Name: MERCY LIFE OF ALABAMA

Contract Number: H4074 Organization Marketing Name: Mercy LIFE of Alabama Parent

Organization: Mercy Medical

Organization Type: National PACE Contact Title: CFO Plan Type: National PACE Name: Necie Borroni



Address: 101 Villa Drive Legal Entity Address: 2900 Springhill Ave. PO Box 1090 City: Daphne

City: Mobile State: AL State: AL Zip: 36526


Zip: 36607 Last Updated: 09/02/2011 Legal Entity Name: MERCY LIFE, INC. Contract Number: H0809

Organization Marketing Name: Mercy LIFE Parent Organization: Sisters of Providence Care

Centers, Inc.

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Joseph Larkin



Address: 2112 Riverdale Street Legal Entity Address: 271 Carew Street Suite 1

City: West Springfield City: Springfield State: MA


Legal Entity Name: MERIDIAN HEALTH PLAN OF

ILLINOIS, INC. Contract Number: H5779 Organization Marketing Name: Meridian Health Plan

Parent Organization: Caidan Enterprises, Inc.

Organization Type: Local CCP Contact Title: Deputy Director of Medicare Operations Plan Type: HMO/HMOPOS Name: Danielle Devine



Address: 777 Woodward Avenue Legal Entity Address: 333 South Wabash Avenue Suite 600

Suite 2900 City: Detroit City: Chicago State: MI



ILLINOIS, INC. Contract Number: H6080 Organization Marketing Name: Meridian Complete


Organization Type: Demo Contact Title: Deputy Director of Medicare Operations Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Danielle Devine



Address: 777 Woodward Avenue Legal Entity Address: 333 South Wabash Avenue Suite 600

Suite 2900 City: Detroit City: Chicago State: MI


Legal Entity Name: MERIDIAN HEALTH PLAN OF IOWA,

INC. Contract Number: H5786 Organization Marketing Name: Meridian Health Plan





Tax Status: For Profit Extension: CMS Region Responsible: Chicago Fax:

Enrollment: 350 Email: [email protected] Address: 777 Woodward Avenue

Legal Entity Address: 666 Grand Avenue Suite 600 14th Floor City: Detroit

City: Des Moines State: MI State: IA Zip: 48226

Zip: 50309 Last Updated: 07/06/2015 Legal Entity Name: MERIDIAN HEALTH PLAN OF

MICHIGAN, INC. Contract Number: H0480 Organization Marketing Name: Meridian Complete


Organization Type: Demo Contact Title: Deputy Director of Medicare Operations Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Danielle Devine







MICHIGAN, INC. Contract Number: H5475 Organization Marketing Name: Meridian Health Plan








Legal Entity Name: METROPLUS HEALTH PLAN,

INC. Contract Number: H0423 Organization Marketing Name: MetroPlus Health Plan

Parent Organization: New York City Health and Hospitals

Corporation




Legal Entity Address: 160 Water Street 3rd Floor

City: New York

Contact Title: Director Communications Name: Kathryn Soman Phone: 1-212-908-8588


Email: [email protected] Address: 160 Water Street

3rd Floor City: New York

State: NY Zip: 10038



State: NY

Zip:

10038

Legal Entity Name: METROPLUS HEALTH PLAN,

INC. Contract Number: H9115 Organization Marketing Name: MetroPlus FIDA

Parent Organization: New York City Health and Hospitals

Corporation

Organization Type: Demo Contact Title: Director of Communications Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Kathryn Soman



Address: 160 Water Street Legal Entity Address: 160 Water Street 4th floor

3rd Floor City: New York City: New York State: NY


Legal Entity Name: MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION

Contract Number: H3810 Organization Marketing Name: AllCare Advantage

Parent Organization: Mid Rogue IPA Holding Company Organization Type: Local CCP Contact Title: Vice President of Marketing and Communication Plan Type: HMO/HMOPOS Name: Freddy Sennhauser

Contract Effective Date: 05/01/2005 Phone: 1-888-460-0185 Tax Status: For Profit Extension: CMS Region Responsible: Seattle Fax: 1-541-471-1524 Enrollment: 2,090 Email: [email protected]

Address: 740 SE 7th Street Legal Entity Address: 740 SE 7th Street

City: Grants Pass City: GRANTS PASS State: OR State: OR Zip: 97526 Zip: 97526 Last Updated: 05/07/2014

Legal Entity Name: MIDLAND CARE CONNECTION

Contract Number: H5822 Organization Marketing Name: Midland Care PACE

Parent Organization: Midland Care Connection, Inc.

Organization Type: National PACE Contact Title: VP Compliance Plan Type: National PACE Name: Harmony Hines



Address: 200 SW Frazier Circle Legal Entity Address: 200 SW Frazier Circle

City: Topeka


City: Topeka State: KS State: KS Zip: 66606

Zip: 66606 Last Updated: 05/01/2013 Legal Entity Name: MMM HEALTHCARE, LLC.

Contract Number: H4003 Organization Marketing Name: Medicare y Mucho Mßs Parent

Organization: InnovaCare Inc.




Legal Entity Address: 350 Chardon Ave Suite 500 Torre Chardon

City: San Juan State: PR

Zip: 009182137

Contact Title: AVP Enrollment and Membership Accounting

Name: Yamile Suarez Phone: 1-787-622-3000 Extension: 1745


Address: 350 Avénida Chardón Torre Chardón, Suite 500


Zip: 00918-2137 Last Updated: 12/30/2013

Legal Entity Name: MMM HEALTHCARE, LLC.

Contract Number: H4011 Organization Marketing Name: First +Plus

Parent Organization: InnovaCare Inc.

Organization Type: Local CCP Contact Title: AVP Enrollment and Membership Accounting Plan Type: Local PPO Name: Yamile Suarez



Address: 350 Avénida Chardón Legal Entity Address: PO BOX 195080 Torre Chardón, Suite 500 City: San

Juan City: SAN JUAN State: PR

State: PR Zip: 00918-2137 Zip: 009195080 Last Updated: 12/16/2014

Legal Entity Name: MODA HEALTH PLAN, INC.

Contract Number: H3813 Organization Marketing Name: Moda Health Plan, Inc.

Parent Organization: Moda, Inc.

Organization Type: Local CCP Contact Title: Member Services Plan Type: Local PPO Name: Member Services



Address: 601 S.W. Second Ave. Legal Entity Address: 601 SW Second Avenue Suite

900 City: Portland City: Portland State: OR


Legal Entity Name: MODA HEALTH PLAN, INC.

Contract Number: H8506 Organization Marketing Name: Moda Health Plan, Inc.

Parent Organization: Moda, Inc.

Organization Type: Local CCP Contact Title: Member Services Plan Type: HMO/HMOPOS Name: Member Services



CMS Region Responsible: Seattle Fax: Enrollment: 75 Email: [email protected] Address:

601 S.W. Second Ave. Legal Entity Address: 601 SW Second Ave Suite 900

City: Portland City: Portland State: OR


Legal Entity Name: MOLINA HEALTHCARE OF

CALIFORNIA Contract Number: H5810 Organization Marketing Name: Molina Healthcare of

California Parent Organization: Molina

Healthcare, Inc.,




Legal Entity Address: 200 Oceangate Suite 100


Zip:

90802

Contact Title: Vice President Name: Tom Standring Phone: 1-800-665-


Address: 200 Oceangate Suite 100




CALIFORNIA Contract Number: H8677 Organization Marketing Name: Molina Healthcare of

California Parent Organization: Molina Healthcare,

Inc.,

Organization Type: Demo Contact Title: Vice President Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Tom Standring



Address: 200 Oceangate Legal Entity Address: 200 Oceangate Suite 100

Ste. 100 City: Long Beach City: Long Beach State: CA



FLORIDA, INC. Contract Number: H8130 Organization Marketing Name: Molina Healthcare of

Florida Parent Organization: Molina Healthcare,

Inc.,

Organization Type: Local CCP Contact Title: Vice President Plan Type: HMO/HMOPOS Name: Tom Standring



Address: 200 Oceangate


Legal Entity Address: 8300 NW 33rd Street, Suite 400 Suite 100

City: Long Beach City: Doral State: CA



ILLINOIS, INC. Contract Number: H8046 Organization Marketing Name: Molina Healthcare of Illinois

Parent Organization: Molina Healthcare, Inc.,





Address: 200 Oceangate Legal Entity Address: 1520 Kensington Road Suite 100

Ste. 212 City: Long Beach City: Oakbrook State: CA



MICHIGAN, INC. Contract Number: H5926 Organization Marketing Name: Molina Healthcare of

Michigan Parent Organization: Molina

Healthcare, Inc.,




Legal Entity Address: 100 W. Big Beaver Suite 600

City: Troy State: MI

Zip: 48084

Contact Title: Vice President Name: Tom Standring Phone: 1-800-665-






MICHIGAN, INC. Contract Number: H7844 Organization Marketing Name: Molina Healthcare of

Michigan Parent Organization: Molina Healthcare,

Inc.,





Address: 200 Oceangate Legal Entity Address: 100 W. Big Beaver Road Suite 100

Ste. 600 City: Long Beach City: Troy State: CA



Legal Entity Name: MOLINA HEALTHCARE OF NEW

MEXICO, INC. Contract Number: H9082 Organization Marketing Name: Molina Healthcare of New

Mexico, Inc. Parent Organization: Molina Healthcare,

Inc.,




Address: 200 Oceangate Legal Entity Address: 8801 Horizon Blvd., Suite 400 Suite 100

City: Long

Beach City: Albuquerque State: CA

State: NM Zip: 90802 Zip: 87113 Last Updated: 03/06/2013

Legal Entity Name: MOLINA HEALTHCARE OF OHIO,

INC. Contract Number: H0490 Organization Marketing Name: Molina Healthcare of Ohio




CMS Region Responsible: Seattle Fax: Enrollment: 565 Email: [email protected]

Address: 200 Oceangate Legal Entity Address: 3000 Corporate Exchange Drive Suite 100 City:

Long Beach City: Columbus State: CA


Legal Entity Name: MOLINA HEALTHCARE OF OHIO,

INC. Contract Number: H5280 Organization Marketing Name: Molina Healthcare of Ohio






Address: 200 Oceangate Legal Entity Address: 3000 Corporate Exchange Drive Suite 100 City:

Long Beach City: Columbus State: CA


Legal Entity Name: MOLINA HEALTHCARE OF SOUTH

CAROLINA, INC. Contract Number: H2533 Organization Marketing Name: Molina Healthcare of South

Carolina Parent Organization: Molina Healthcare,

Inc.,

Organization Type: Demo Contact Title: Vice President Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Tom Standring



Tax Status: For Profit Extension: CMS Region Responsible: Atlanta Fax:

Enrollment: 173 Email: [email protected] Address: 200 Oceangate

Legal Entity Address: 200 Oceangate - Suite 100 Suite 100

City: Long

Beach City: Long Beach State: CA


Legal Entity Name: MOLINA HEALTHCARE OF TEXAS, INC.

Contract Number: H7678 Organization Marketing Name: Molina Healthcare of Texas, Inc.





Address: 200 Oceangate Legal Entity Address: 2505 North Hwy 360, Suite 300 Suite 100 City: Long

Beach City: Grand Prairie State: CA


Legal Entity Name: MOLINA HEALTHCARE OF TEXAS, INC.

Contract Number: H8197 Organization Marketing Name: Molina Healthcare of Texas


Organization Type: Demo Contact Title: Vice President Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Tom Standring



Address: 200 Oceangate Legal Entity Address: 84 NE Loop 410 Suite 100

Ste. 400 City: Long Beach City: San Antonio State: CA


Legal Entity Name: MOLINA HEALTHCARE OF UTAH, INC.

Contract Number: H5628 Organization Marketing Name: Molina Healthcare of Utah





Legal Entity Address: 7050 Union Park Center Suite 200

City: Midvale State: UT

Zip: 84047

Contact Title: Vice President Name: Tom Standring Phone: 1-800-665-0898







WASHINGTON, INC. Contract Number: H5823 Organization Marketing Name: Molina Healthcare of Washington,

Inc. Parent Organization: Molina Healthcare, Inc.,




Address: 200 Oceangate Legal Entity Address: 21540 30th Dr. SE Suite 100

Suite 400 City: Long Beach City: Bothell State: CA


Legal Entity Name: MOLINA HEALTHCARE OF WISCONSIN

Contract Number: H2879 Organization Marketing Name: Molina Healthcare of Wisconsin





Address: 200 Oceangate Legal Entity Address: 2400 South 102nd Street Suite 100 City: Long

Beach City: West Allis State: CA


Legal Entity Name: MORSE LIFE HOME CARE, INC.

Contract Number: H0112 Organization Marketing Name: Palm Beach PACE

Parent Organization: Morse Life Home Care, Inc.

Organization Type: National PACE Contact Title: Director of Information Technology Plan Type: National PACE Name: Michael Schultz


CMS Region Responsible: Atlanta Fax: 1-561-683-4556 Enrollment: 157 Email: [email protected] Address: 4847

Fred Gladstone Dr. Legal Entity Address: 4847 Fred Gladstone Drive

City: West Palm Beach City: West Palm Beach State: FL


Legal Entity Name: MOUNT CARMEL HEALTH INSURANCE

COMPANY Contract Number: H1846 Organization Marketing Name: MediGold






Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: Chicago

Enrollment: 1,423

Legal Entity Address: 6150 E. Broad St. EE320


Zip: 43213

Contact Title: Provider Relations Call

Center Name: Provider Call Center Phone: 1-800-991-9907


Email: [email protected] Address: 6150 E. Broad St, EE320



Legal Entity Name: MOUNT CARMEL HEALTH PLAN, INC.

Contract Number: H3668 Organization Marketing Name: MediGold


Organization Type: Local CCP Contact Title: Provider Relations Call Center Plan Type: HMO/HMOPOS Name: Provider Call Center


CMS Region Responsible: Chicago Fax: 1-614-546-4269 Enrollment: 49,112 Email: [email protected] Address: 6150

E. Broad St, EE320 Legal Entity Address: 6150 East Broad Street, EE320

City: Columbus City: Columbus State: OH


Legal Entity Name: MOUNTAIN EMPIRE OLDER CITIZENS,

INC. Contract Number: H5037 Organization Marketing Name: Mountain Empire PACE

Parent Organization: Mountain Empire Older Citizens, Inc

Organization Type: National PACE Contact Title: PACE Director and COO Plan Type: National PACE Name: Tony Lawson


CMS Region Responsible: Philadelphia Fax: 1-276-523-6483 Enrollment: 94 Email: [email protected] Address:

P. O. Box 888 Legal Entity Address: 1501 Third Avenue East

P.O. Box 888 City: Big Stone Gap City: Big Stone Gap State: VA


Legal Entity Name: MVP HEALTH PLAN, INC. Contract Number: H3305

Organization Marketing Name: MVP HEALTH CARE Parent Organization: MVP Health Care, Inc.

Organization Type: Local CCP Contact Title: Sales Manager, Medicare Plan Type: HMO/HMOPOS Name: Catherine Mercury



Address: 220 Alexander St


Legal Entity Address: 220 Alexander Street City: Rochester

City: Rochester State: NY State: NY Zip: 14607

Zip: 14607 Last Updated: 05/18/2009 Legal Entity Name: MVP HEALTH PLAN, INC. Contract Number: H9615


Organization Type: Local CCP Plan Type: Local PPO Contract Effective Date: 01/01/2009


Enrollment: 20,295

Legal Entity Address: 625 State Street

City: Schenectady State: NY Zip: 12301

Contact Title: Sales Manager, Medicare Name: Catherine

Mercury Phone: 1-888-280-6205 Extension: Fax: Email: [email protected] Address: 220 Alexander

St

City: Rochester State: NY


Legal Entity Name: MVP HEALTH PLAN, INC. Contract Number: H9859


Organization Type: Local CCP Contact Title: Sales Manager, Medicare Plan Type: HMO/HMOPOS Name: Catherine Mercury



Address: 220 Alexander St Legal Entity Address: 625 State Street

City: Rochester City: Schenectady State: NY


Legal Entity Name: NETWORK HEALTH INSURANCE

CORPORATION Contract Number: H1181 Organization Marketing Name: Network Health Medicare Advantage

Plans Parent Organization: Ministry Health Care, Inc.

Organization Type: MSA Contact Title: Plan Type: MSA Name: Customer Service



Address: 1570 Midway Place Legal Entity Address: 1570 Midway Place P.O. Box 120

P.O. Box 120 City: Menasha City: Menasha State: WI


Legal Entity Name: NETWORK HEALTH INSURANCE

CORPORATION Contract Number: H5215 Organization Marketing Name: Network Health Medicare Advantage

Plans Parent Organization: Ministry Health Care, Inc.





Address: 1570 Midway Place Legal Entity Address: 1570 MIDWAY PLACE P.O. Box 120

P.O. Box 120 City: Menasha City: MENASHA State: WI


Legal Entity Name: NEW WEST HEALTH SERVICES Contract

Number: H2701 Organization Marketing Name: New West Health Services Parent

Organization: New West Health Services

Organization Type: Local CCP Plan Type: Local


Tax Status: Not-for-Profit/Non-Profit CMS Region Responsible: Denver

Enrollment: 18,082

Legal Entity Address: 130 NEILL AVE

City: HELENA State: MT

Zip: 59601

Contact Title: VP of Operations and Compliance Officer Name: Alissa

Beattie Phone: 1-888-873-8049 Extension:

Fax: 1-406-457-2299 Email: [email protected] Address: 130 Neill

Avenue

City: Helena State: MT


Legal Entity Name: NEWCOURTLAND LIFE

PROGRAM Contract Number: H9830 Organization Marketing Name: NewCourtland LIFE Program

Parent Organization: New Courtland LIFE Program

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Silvia Boswell



Address: NewCourtland LIFE Program Legal Entity Address: 1845 Walnut Street 6970 Germantown Avenue

12th Floor City: Philadelphia City: Philadelphia State: PA


Legal Entity Name: NORTH SHORE-LIJ HEALTH

PLAN, INC. Contract Number: H3129 Organization Marketing Name: North Shore-LIJ Health Plan,

Inc. Parent Organization: North Shore-LI Jewish Health

System, Inc.

Organization Type: Demo Contact Title: Chief Provider Relations and Contracting

Officer Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Sandra Galian



Address: North Shore-LIJ Health Plan Legal Entity Address: 2200 Northern Boulevard 2200 Northern Boulevard, Suite 104


Suite 104 City: East Hills City: East Hills State: NY


Legal Entity Name: NORTHLAND PACE

PROGRAM Contract Number: H7195 Organization Marketing Name: Northland PACE Senior Care

Services Parent Organization: Northland Healthcare

Alliance

Organization Type: National PACE Contact Title: President Plan Type: National PACE Name: Tim Cox


CMS Region Responsible: Denver Fax: 1-701-250-0739 Enrollment: 117 Email: [email protected]

Address: 2223 East Rosser Avenue Legal Entity Address: 2223 East Rosser Avenue

City: Bismarck City: Bismarck State: ND

State: ND Zip: 58501 Zip: 58501 Last Updated: 05/01/2015

Legal Entity Name: NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC

Contract Number: H6334 Organization Marketing Name: NY Hotel Trades Council and Hotel Assn. of NYC

Parent Organization: NY Hotel Trades Council&Hotel Assn of NYC Organization Type: HCPP - 1833 Cost Contact Title: Compliance Officer, Government Programs Plan Type: HCPP - 1833 Cost Name: Jordan Beasley


Extension: CMS Region Responsible: New York Fax: Enrollment: 4,342 Email: [email protected]

Address: 305 West 44th Street Legal Entity Address: 305 WEST 44TH STREET

City: New York City: NEW YORK State: NY State: NY Zip: 11101 Zip: 10036 Last Updated: 12/27/2007

Legal Entity Name: OKLAHOMA SUPERIOR SELECT, INC.

Contract Number: H3708 Organization Marketing Name: Tribute Health Plan of Oklahoma Parent

Organization: Healthcare Investors, LLC

Organization Type: Local CCP Contact Title: Marketing & Education Director Plan Type: HMO/HMOPOS Name: Doug Shackelford



Address: 1401 West Capitol Ave, Suite 430 Legal Entity Address: 909 S. Meridian Ave.

Suite 510 City: Little Rock City: Oklahoma City State: AR


Legal Entity Name: ON LOK SENIOR HEALTH SERVICES

Contract Number: H5403 Organization Marketing Name: On Lok Lifeways Parent

Organization: On Lok, Inc.


Organization Type: National PACE Contact Title: Health Plan Associate Plan Type: National PACE Name: Edward Chung



Address: 1333 Bush Street Legal Entity Address: 1333 BUSH STREET

City: San Francisco City: SAN FRANCISCO State: CA


Legal Entity Name: ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC. Contract Number: H5430 Organization Marketing Name: Care1st+

Parent Organization: Care1st Health Plan

Organization Type: Local CCP Contact Title: Compliance Officer Plan Type: HMO/HMOPOS Name: Patty Dal

Soglio Contract Effective Date: 09/01/2005 Phone: 1-602-778-8302 Tax Status: For Profit Extension:


Address: 2355 E. Camelback Rd., Ste 300 Legal Entity Address: 2355 E. CAMELBACK ROAD, SUITE 300

City: Phoenix City: PHOENIX State: AZ State: AZ Zip: 85016 Zip: 85016 Last Updated: 12/18/2012

Legal Entity Name: OPTIMA HEALTH PLAN Contract Number: H2563

Organization Marketing Name: Optima Medicare Parent Organization: Sentara Health Care (SHC)




Legal Entity Address: 4417 Corporation lane

City: Virginia Beach State: VA

Zip: 23462

Contact Title: Medicare Contract

Administrator Name: William Miller Phone: 1-757-687-6251


Email: [email protected] Address: 4417 Corporation Lane

City: Virginia Beach State: VA


Legal Entity Name: OPTIMUM HEALTHCARE, INC.

Contract Number: H5594 Organization Marketing Name: Optimum HealthCare, Inc.

Parent Organization: America's 1st Choice Holdings of

Florida, LLC

Organization Type: Local CCP Contact Title: Sr. VP Operations Plan Type: HMO/HMOPOS Name: Chris O'Connor



Address: 3707 W. Cherry Street


Legal Entity Address: 5403 N. Church Ave City: Tampa

City: Tampa State: FL State: FL Zip: 33607

Zip: 33614 Last Updated: 02/19/2015 Legal Entity Name: ORANGE COUNTY HEALTH

AUTHORITY Contract Number: H5433 Organization Marketing Name: OneCare

Parent Organization: Orange County Health Authority




Address: 505 City Parkway West Legal Entity Address: 505 City Parkway West

City: Orange City: Orange State: CA


Legal Entity Name: ORANGE COUNTY HEALTH

AUTHORITY Contract Number: H7501 Organization Marketing Name: CalOptima PACE


Organization Type: National PACE Contact Title: Director of PACE Plan Type: National PACE Name: Rena Smith

Contract Effective Date: 09/01/2013 Phone: 1-714-468-1047 Tax Status: Not Applicable Extension:


Address: 13300 Garden Grove

Boulevard Legal Entity Address: 505 City Parkway West

City: Garden Grove City: Orange State: CA


Legal Entity Name: ORANGE COUNTY HEALTH

AUTHORITY Contract Number: H8016 Organization Marketing Name: OneCare Connect



HMO/HMOPOS Name: Customer Service



Address: 505 City Parkway West Legal Entity Address: 505 City Parkway West

City: Orange City: Orange State: CA



Legal Entity Name: OXFORD HEALTH PLANS

(CT), INC. Contract Number: H0755 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 48 Monroe Turnpike

City: Hot Springs City: Trumbull State: AR



(NJ), INC. Contract Number: H3107 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 48 Monroe Turnpike

City: Hot Springs City: Trumbull State: AR



(NJ), INC. Contract Number: H3113 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 44 SOUTH BROADWAY

City: Hot Springs City: WHITE PLAINS State: AR



(NY), INC. Contract Number: H3307 Organization Marketing Name: UnitedHealthcare






Legal Entity Address: 48 Monroe Turnpike

City: Trumbull State: CT

Zip: 06611




City: Hot Springs State: AR


Legal Entity Name: PACE @ HOME, INC. Contract Number: H4326

Organization Marketing Name: PACE@Home Parent Organization: PACE @ Home

Organization Type: National PACE Contact Title: Program Director Plan Type: National PACE Name: Emily Jones


CMS Region Responsible: Atlanta Fax: 1-828-464-2845 Enrollment: 100 Email: [email protected] Address:

1915 Fairgrove Church Rd. SE Legal Entity Address: 1915 Fairgrove Church Road SE

City: Newton City: Newton State: NC


Legal Entity Name: PACE GREATER NEW

ORLEANS Contract Number: H1904 Organization Marketing Name: Pace Greater New Orleans

Parent Organization: Catholic Charities Archdiocese of

New Orleans

Organization Type: National PACE Contact Title: Decision Support Manager Plan Type: National PACE Name: Kurt Wootan



Address: 4201 N RAMPART ST Legal Entity Address: 4201 N. Rampart Street

City: NEW ORLEANS City: NEW ORLEANS State: LA


Legal Entity Name: PACE IOWA Contract Number: H0216

Organization Marketing Name: Immanuel Pathways Iowa Parent

Organization: Immanuel

Organization Type: National PACE Contact Title: VP of Home and Community Resources Plan Type: National PACE Name: Jill Nyquist


CMS Region Responsible: Kansas City Fax: 1-402-829-2998 Enrollment: 116 Email: [email protected] Address: 1044

North 115th Street, Suite 500


Legal Entity Address: 1702 North 16th Street City: Omaha

City: Council Bluffs State: NE State: IA Zip: 68154

Zip: 51501 Last Updated: 06/26/2015 Legal Entity Name: PACE NEBRASKA Contract Number: H7003

Organization Marketing Name: Immanuel Pathways Omaha

Parent Organization: Immanuel

Organization Type: National PACE Contact Title: VP of Home and Community Resources Plan Type: National PACE Name: Jill Nyquist


CMS Region Responsible: Kansas City Fax: 1-402-829-2998 Enrollment: 97 Email: [email protected] Address: 1044

North 115th Street, Suite 500 Legal Entity Address: 5755 Sorensen Parkway

City: Omaha City: Omaha State: NE


Legal Entity Name: PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC. Contract Number:

H6059 Organization Marketing Name: PACE OF THE TRIAD

Parent Organization: PACE of Guilford and Rockingham Counties, Inc. Organization Type: National PACE Contact Title: Outreach Coordinator Plan Type: National PACE Name: Nedra Baldwin

Contract Effective Date: 06/01/2011 Phone: 1-336-550-4040 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Atlanta Fax: 1-336-550-4044 Enrollment: 159 Email: [email protected]

Address: 1471 East Cone Blvd Legal Entity Address: 1471 E. Cone Blvd

City: Greensboro City: Greensboro State: NC State: NC Zip: 27405 Zip: 27405 Last Updated: 06/06/2013

Legal Entity Name: PACE OF SOUTHWEST

MICHIGAN, INC. Contract Number: H0390 Organization Marketing Name: PACE of Southwest Michigan

Parent Organization: PACE of Southwest Michigan, Inc.

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Therese Saggau



Address: 2900 Lakeview Avenue Legal Entity Address: 2900 Lakeview Avenue

City: St Joseph City: St. Joseph State: MI


Legal Entity Name: PACE OF THE SOUTHERN

PIEDMONT, INC. Contract Number: H4714


Organization Marketing Name: PACE of the Southern

Piedmont, Inc. Parent Organization: PACE of the

Southern Piedmont, Inc.

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Toni Maddox



Address: 6133 The Plaza Legal Entity Address: 6133 The Plaza

City: Charlotte City: Charlotte State: NC


Legal Entity Name: PACE ORGANIZATION OF RHODE

ISLAND Contract Number: H4105 Organization Marketing Name: Pace Organization Of Rhode

Island Parent Organization: PACE Organization of Rhode

Island



CMS Region Responsible: Boston Enrollment: 260

Legal Entity Address: 225 CHAPMAN STREET

City: PROVIDENCE State: RI

Zip: 02905

Contact Title: CEO Name: Joan L Kwiatkowski Phone: 1-401-490-6566



Address: 225 Chapman Street, Box 7

City: Providence State: RI


Legal Entity Name: PACIFICARE OF COLORADO, INC

Contract Number: H0609 Organization Marketing Name: UnitedHealthcare




CMS Region Responsible: San Francisco Fax: Enrollment: 100,171 Email: [email protected] Address: P.O.

Box 29675 Legal Entity Address: 6455 YOSEMITE STREET

City: Hot Springs City: GREENWOOD VILLAG State: AR


Legal Entity Name: PACIFICSOURCE COMMUNITY

HEALTH PLANS Contract Number: H3864 Organization Marketing Name: PacificSource Medicare

Parent Organization: PacificSource Health Plans

Organization Type: Local CCP Contact Title: Medicare Marketing Manager Plan Type: HMO/HMOPOS Name: Brad Westphal




Address: 2965 NE Conners Ave. Legal Entity Address: 2965 NE Conners Ave.

City: Bend City: BEND State: OR


Legal Entity Name: PACIFICSOURCE COMMUNITY

HEALTH PLANS Contract Number: H4754 Organization Marketing Name: PacificSource Medicare

Parent Organization: PacificSource Health Plans

Organization Type: Local CCP Contact Title: Medicare Marketing Manager Plan Type: Local PPO Name: Brad Westphal



Address: 2965 NE Conners Ave. Legal Entity Address: 2965 NE Conners Ave.

City: Bend City: Bend State: OR


Legal Entity Name: PALMETTO HEALTH ALLIANCE

Contract Number: H4203 Organization Marketing Name: Palmetto SeniorCare PACE

Parent Organization: Palmetto Health Alliance




Legal Entity Address: 15 Richland Medical Park Drive Suite 203

City: COLUMBIA State: SC

Zip: 29203

Contact Title: Planning and Marketing Coordinator Name:

Jacqueline Chappell Phone: 1-803-434-3770 Extension:


Address: 15 Richland Medical Park Drive Suite 203



Legal Entity Name: PARAMOUNT CARE, INC.

Contract Number: H3653 Organization Marketing Name: Paramount Elite

Parent Organization: Promedica Health System

Organization Type: Local CCP Contact Title: Member Services Dept. Plan Type: HMO/HMOPOS Name: Member Services



Address: 1901 Indian Wood Circle Legal Entity Address: 1901 INDIAN WOOD

CIRCLE P.O. Box 928, Toledo, Ohio 43697

P.O. Box 928, Toledo, Ohio

43697 City: Maumee

City: Maumee State: OH State: OH Zip: 43537



Legal Entity Name: PEACH STATE HEALTH

PLAN, INC. Contract Number: H7173 Organization Marketing Name: Peach State Health Plan


Organization Type: Local CCP Contact Title: VP, Medicare Operations Plan Type: HMO/HMOPOS Name: Dietrick Williams



Address: 3200 Highlands Parkway SE Legal Entity Address: 1100 Circle 75 Parkway Suite 300

Suite 1100 City: Smyrna City: Atlanta State: GA


Legal Entity Name: PENNSYLVANIA PACE,

INC. Contract Number: H3925 Organization Marketing Name: Senior LIFE Johnstown

Parent Organization: Pennsylvania PACE, Inc.

Organization Type: National PACE Contact Title: Chief Executive Officer Plan Type: National PACE Name: Mark Irwin



Address: 401 Broad Street Legal Entity Address: 209 Sigma Drive

City: Johnstown City: Pittsburgh State: PA


Legal Entity Name: PEOPLES HEALTH, INC. Contract Number: H1961

Organization Marketing Name: Peoples Health Parent Organization: PH Holdings, LLC

Organization Type: Local CCP Contact Title: Director Provider Relations Plan Type: HMO/HMOPOS Name: Meghan Courtney



Address: Three Lakeway Center Legal Entity Address: Three Lakeway Center 3838 N Causeway Blvd, Suite 2200

3838 N Causeway Blvd., Suite

2200 City: Metairie

City: Metairie State: LA State: LA Zip: 70002


Legal Entity Name: PHOENIX HEALTH PLANS, INC.

Contract Number: H5985 Organization Marketing Name: Phoenix Health Plans


Organization Type: Local CCP Contact Title: Member Services Department Plan Type: HMO/HMOPOS Name: Member Services




Enrollment: 12,717 Email: [email protected] Address:

7878 N. 16th St. Legal Entity Address: 7878 N. 16th St. Suite 105

Suite 105 City: Phoenix City: Phoenix State: AZ


Legal Entity Name: PHYSICIANS HEALTH CHOICE OF

TEXAS LLC Contract Number: H4527 Organization Marketing Name: PHYSICIANS HEALTH

CHOICE Parent Organization: UnitedHealth

Group, Inc.




Address: P.O. Box 29675 Legal Entity Address: 8637 FREDERICKSBURG ROAD,

SUITE 360 City: Hot Springs City: SAN ANTONIO State: AR


Legal Entity Name: PIEDMONT COMMUNITY

HEALTHCARE, INC. Contract Number: H1659 Organization Marketing Name: Piedmont Medicare Advantage

Parent Organization: Piedmont Community Health Plan

Organization Type: Local CCP Contact Title: Medicare Advantage Product Manager Plan Type: Local PPO Name: Lorie H Beneke



Address: 2316 Atherholt Road Legal Entity Address: 2316 Atherholt Road

City: Lynchburg City: Lynchburg State: VA


Legal Entity Name: PIEDMONT HEALTH SERVICES,

INC. Contract Number: H9266 Organization Marketing Name: Piedmont Health SeniorCare

Parent Organization: PIEDMONT HEALTH SERVICES,

INC.




Legal Entity Address: 1214 Vaughn Road

City: Burlington State: NC

Zip: 27217

Contact Title: Executive Director, Piedmont Health SeniorCare Name: Marianne C Ratcliffe Phone: 1-336-532-0000 Extension:


Address: 1214 Vaughn Road

City: Burlington State: NC



Legal Entity Name: PITTSBURGH CARE

PARTNERSHIP, INC. Contract Number: H3917 Organization Marketing Name: Community LIFE

Parent Organization: UPMC Health System

Organization Type: National PACE Contact Title: DIRECTOR OF MARKETING AND PUBLIC

RELATIONS Plan Type: National PACE Name: STACI KACZKOWSKI



Address: SUITE # 700 Legal Entity Address: 2400 ARDMORE BOULEVARD,

SUITE 700 2400 ARDMORE

BOULEVARD City: PITTSBURGH City: PITTSBURGH State: PA


Legal Entity Name: PMC MEDICARE CHOICE, LLC

Contract Number: H4004 Organization Marketing Name: PMC Medicare Choice

Parent Organization: InnovaCare Inc.

Organization Type: Local CCP Contact Title: AVP Enrollment and Membership Accounting Plan Type: HMO/HMOPOS Name: Yamile Suarez



Address: 350 Avénida Chardón Legal Entity Address: 350 Chard≤n Avenue Torre Chardón, Suite 500

Suite 500, Torre Chard≤n City: San Juan City: San Juan State: PR

State: PR Zip: 00918-2137 Zip: 009182137 Last Updated: 12/30/2013

Legal Entity Name: PREFERRED CARE

PARTNERS, INC. Contract Number: H1045 Organization Marketing Name: Preferred Care Partners, Inc.


Organization Type: Local CCP Contact Title: Compliance Officer Plan Type: HMO/HMOPOS Name: Annette C Onorati



Address: 9100 South Dadeland Blvd Legal Entity Address: 9100 SOUTH DADELAND

BLVD. Suite 1250

SUITE 1250 City: Miami City: MIAMI State: FL


Legal Entity Name: PREMERA BLUE CROSS Contract Number: H7245

Organization Marketing Name: Premera Blue Cross Medicare

Advantage Parent Organization: Premera





Legal Entity Address: 7001 220th St SW

City: Mountlake Terrace State: WA

Zip: 98043






Legal Entity Name: PREMIER HEALTH INSURING

CORPORATION Contract Number: H3233 Organization Marketing Name: Premier Health Plan

Parent Organization: Premier Health Partners

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Kelli Tittle



Address: 110 North Main Street Legal Entity Address: 110 N Main Street Suite 1200

Suite 1200 City: Dayto City: Dayton State: OH


Legal Entity Name: PRESBYTERIAN HEALTH PLAN

Contract Number: H3204 Organization Marketing Name: Presbyterian Senior Care (HMO)

Parent Organization: Presbyterian Healthcare Services

Organization Type: Local CCP Contact Title: Presbyterian Customer Service Center Plan Type: HMO/HMOPOS Name: PCSC Provider Care Unit


CMS Region Responsible: Dallas Fax: 1-505-923-5124 Enrollment: 33,692 Email: [email protected] Address: P.O.

Box 27489 Legal Entity Address: 9521 San Mateo Blvd. NE 9521 San Mateo Blvd NE - Coop

P.O. Box 27489 City: Albuquerque City: Albuquerque State: NM


Legal Entity Name: PRESBYTERIAN INSURANCE

COMPANY, INC. Contract Number: H3206 Organization Marketing Name: Presbyterian MediCare PPO

Parent Organization: Presbyterian Healthcare Services

Organization Type: Local CCP Contact Title: Presbyterian Customer Service Center Plan Type: Local PPO Name: PCSC Provider Care Unit



Address: P.O. Box

27489 Legal Entity Address: P.O. Box 27489 9521 San Mateo Blvd NE - Coop

9521 San Mateo Blvd. NE City: Albuquerque City: Albuquerque State: NM



Legal Entity Name: PRIMEWEST CTRL COUNTY-BASED PURCHASING INITIATIVE Contract Number:

H2416 Organization Marketing Name: PrimeWest Health

Parent Organization: PrimeWest Central County-Based Purchasing Initiati Organization Type: Local CCP Contact Title: Director of Communications Plan Type: HMO/HMOPOS Name: Beth Hendrickson


Extension: CMS Region Responsible: Chicago Fax: 1-320-762-8750 Enrollment: 1,931 Email: [email protected]

Address: PrimeWest Health Legal Entity Address: 3905 DAKOTA ST 3905 Dakota St

City: Alexandria City: ALEXANDRIA State: MN State: MN Zip: 56308 Zip: 56308 Last Updated: 03/23/2015

Legal Entity Name: PRIMEWEST CTRL COUNTY-BASED PURCHASING INTIATIVE Contract Number: H2926

Organization Marketing Name: PrimeWest Health Parent Organization: PrimeWest Central County-Based Purchasing Initiati

Organization Type: Local CCP Contact Title: Director of Communications Plan Type: HMO/HMOPOS Name: Beth Hendrickson

Contract Effective Date: 01/01/2008 Phone: 1-320-335-5338 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Chicago Fax: 1-320-762-8750 Enrollment: 256 Email: [email protected]

Address: PrimeWest Health Legal Entity Address: 3905 Dakota St 3905 Dakota St

City: Alexandria City: Alexandria State: MN State: MN Zip: 56308 Zip: 56308 Last Updated: 03/23/2015

Legal Entity Name: PRIORITY HEALTH Contract Number: H2320

Organization Marketing Name: Priority Health Medicare Parent Organization: Spectrum Health System




Address: 1231 East Beltline Ave NE Legal Entity Address: 1231 EAST BELTLINE AVE N.E.

City: Grand Rapids City: GRAND RAPIDS State: MI


Legal Entity Name: PRIORITY HEALTH Contract Number: H4875

Organization Marketing Name: Priority Health Medicare Parent Organization: Spectrum Health System




Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Chicago Fax:

Enrollment: 18,214 Email: [email protected] Address: 1231 East Beltline Ave NE

Legal Entity Address: 1231 E. Beltline Ave. NE City: Grand Rapids

City: Grand Rapids State: MI State: MI Zip: 49525

Zip: 49525 Last Updated: 12/03/2008 Legal Entity Name: PROMINENCE HEALTHFIRST Contract

Number: H5945 Organization Marketing Name: Prominence Health Plan

Parent Organization: Universal Health Services, Inc.




Legal Entity Address: 1510 Meadow Wood Lane

City: Reno State: NV Zip: 89502

Contact Title: Federal and State Medicare Compliance Auditor Name:

Tracy Croxon Phone: 1-775-770-9236 Extension:

Fax: Email: [email protected] Address: 1510

Meadow Wood Ln

City: Reno State: NV


Legal Entity Name: PROMINENCE HEALTHFIRST OF TEXAS

Contract Number: H7680 Organization Marketing Name: Prominence Health Plan

Parent Organization: Universal Health Services, Inc.

Organization Type: Local CCP Contact Title: Federal and State Medicare Compliance Auditor Plan Type: HMO/HMOPOS Name: Tracy Croxon



Address: 1510 Meadow Wood Ln Legal Entity Address: 1510 Meadow Wood Lane

City: Reno City: Reno State: NV

State: NV Zip: 89502 Zip: 89502 Last Updated: 01/06/2015

Legal Entity Name: PROVIDENCE HEALTH & SERVICES -

OREGON Contract Number: H3809 Organization Marketing Name: Providence ElderPlace Portland

Parent Organization: Providence Health & Services

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Rika Bering



Address: 4531 SE Belmont Legal Entity Address: 4531 SE Belmont Suite 100

Suite 100 City: Portland City: PORTLAND State: OR



Legal Entity Name: PROVIDENCE HEALTH PLAN Contract

Number: H9047 Organization Marketing Name: Providence Health Plans


Organization Type: Local CCP Contact Title: Senior Manager, Medicare Compliance Program Plan Type: HMO/HMOPOS Name: Keri Steege


CMS Region Responsible: Seattle Fax: 1-503-574-6543 Enrollment: 47,804 Email: [email protected] Address: 3601 SW

Murray Blvd. Legal Entity Address: 3601 SW MURRAY BLVD. Suite 10

SUITE 10 City: Beaverton City: BEAVERTON State: OR


Legal Entity Name: PROVIDENCE HEALTH

SYSTEM Contract Number: H5007 Organization Marketing Name: Providence Health System





Legal Entity Address: 4515 MARTIN LUTHER KING JR.WAY

SOUTH STE 10

City: SEATTLE State: WA

Zip: 98108

Contact Title: Mgr Admin and Support Svcs Name: Velaa Chinn Phone: 1-206-320-5325


Email: [email protected] Address: 4515 Martin Luther King Jr. Way S. Ste. 100

City: Seattle State: WA


Legal Entity Name: QCC INSURANCE COMPANY

Contract Number: H3909 Organization Marketing Name: Personal Choice 65 PPO




CMS Region Responsible: Philadelphia Fax: Enrollment: 9,032 Email: [email protected] Address: PO

Box 7799 Legal Entity Address: 1901 MARKET STREET

35TH FLOOR City: Philadelphia City: PHILADELPHIA State: PA


Legal Entity Name: QUALITY HEALTH PLANS OF NEW

YORK, INC. Contract Number: H2773 Organization Marketing Name: QUALITY HEALTH

PLANS Parent Organization: QHP Financial

Group, Inc.

Organization Type: Local CCP Contact Title: Compliance Officer Plan Type: HMO/HMOPOS Name: Monique Slater


CMS Region Responsible: New York Fax: 1-631-403-4266


Enrollment: 717 Email: [email protected]

Address: 2805 Veterans Memorial Highway,

Suite 17 Legal Entity Address: 2805 Veterans Memorial Highway,

Suite 17 City: Ronkonkoma City: Ronkonkoma State: NY


Legal Entity Name: REGENCE BLUE SHIELD OF IDAHO

Contract Number: H1304 Organization Marketing Name: Regence BlueShield Of Idaho




CMS Region Responsible: Seattle Fax: Enrollment: 7,966 Email: [email protected] Address:

PO Box 12625 Legal Entity Address: 200 SW Market St



Legal Entity Name: REGENCE BLUE SHIELD OF IDAHO

Contract Number: H1969 Organization Marketing Name: Regence BlueShield of Idaho





Legal Entity Address: 200 SW Market St


Zip: 97201




City: Salem State: OR

Zip: 97309-0625 Last Updated: 01/27/2014

Legal Entity Name: REGENCE BLUECROSS BLUESHIELD

OF OREGON Contract Number: H3817 Organization Marketing Name: Regence BlueCross BlueShield of

Oregon Parent Organization: Cambia Health Solutions,

Inc.




Address: PO Box 12625 Legal Entity Address: 200 SW Market St





OF OREGON Contract Number: H6237 Organization Marketing Name: Regence BlueCross BlueShield of

Oregon Parent Organization: Cambia Health Solutions,

Inc.








OF UTAH Contract Number: H4605 Organization Marketing Name: Regence BlueCross BlueShield of

Utah Parent Organization: Cambia Health Solutions, Inc.








OF UTAH Contract Number: H9110 Organization Marketing Name: Regence BlueCross BlueShield of

Utah Parent Organization: Cambia Health Solutions, Inc.




Legal Entity Address: 200 SW Market St


Zip: 97201




City: Salem State: OR

Zip: 97309-0625 Last Updated: 01/07/2013

Legal Entity Name: REGENCE BLUESHIELD Contract Number: H1997

Organization Marketing Name: Regence BlueShield Parent Organization: Cambia Health Solutions, Inc.



CMS Region Responsible: Seattle Fax:


Enrollment: 1,505 Email: [email protected] Address: PO




Legal Entity Name: REGENCE BLUESHIELD Contract Number: H5009

Organization Marketing Name: Regence BlueShield Parent Organization: Cambia Health Solutions, Inc.



CMS Region Responsible: Seattle Fax: Enrollment: 29,454 Email: [email protected] Address: PO




Legal Entity Name: RIVERLINK HEALTH Contract Number: H9208

Organization Marketing Name: RiverLink Health Parent Organization: Catholic Health Initiatives



CMS Region Responsible: Denver Fax: 1-253-779-8829 Enrollment: 1,062 Email: [email protected] Address:

32129 Weyerhaeuser Way S., Suite 201 Legal Entity Address: 619 Oak St

City: Federal Way City: Cincinnati State: WA


Legal Entity Name: RIVERSIDE RETIREMENT

SERVICES, INC. Contract Number: H8655 Organization Marketing Name: Riverside PACE

Parent Organization: Riverside Healthcare Association




Legal Entity Address: 1020 Old Denbigh Blvd.

City: Newport News State: VA

Zip: 23602

Contact Title: Business Manager

Name: Courtney Berg Phone: 1-757-234-8433



Address: 439 Oriana Road Suite B

City: Newport News State: VA



Legal Entity Name: ROCKY MOUNTAIN HEALTH CARE

SERVICES Contract Number: H5167 Organization Marketing Name: Rocky Mountain PACE

Parent Organization: Rocky Mountain Health Care

Services

Organization Type: National PACE Contact Title: VP Plan Type: National PACE Name: Kris Abbott



Address: 3225 Robinson St Legal Entity Address: 2335 Robinson Street

City: Colorado Springs City: Colorado Springs State: CO


Legal Entity Name: ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION Contract Number:

H0602 Organization Marketing Name: Rocky Mountain Health Plans Parent Organization:

Rocky Mountain HMO, Inc. Organization Type: 1876 Cost Contact Title: Plan Type: 1876 Cost Name: Customer Service

Contract Effective Date: 11/01/1977 Phone: 1-970-243-7050 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Denver Fax: Enrollment: 24,292 Email: [email protected]

Address: PO Box 10600 Legal Entity Address: 2775

CROSSROADS BLVD City: Grand Junction

City: GRAND JUNCTION State: CO State: CO Zip: 81506 Zip: 81506 Last Updated: 04/12/2013

Legal Entity Name: SAMARITAN HEALTH PLANS, INC.

Contract Number: H3811 Organization Marketing Name: Samaritan Advantage Health Plan

Parent Organization: Samaritan Health Services

Organization Type: Local CCP Contact Title: Manager of Marketing Plan Type: HMO/HMOPOS Name: Cristie Lynch



Address: 815 NW 9th Street Legal Entity Address: 815 NW 9TH STREET, SUITE 103 Suite 101

3600 NW Samaritan Dr. City: Corvallis City: CORVALLIS State: OR


Legal Entity Name: SAN MATEO HEALTH COMMISSION

Contract Number: H5428 Organization Marketing Name: Health Plan of San Mateo

Parent Organization: Health Plan of San Mateo

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: CareAdvntg Unit


CMS Region Responsible: San Francisco Fax: Enrollment: 776 Email: [email protected] Address:

701 Gateway Blvd., Suite 400


Legal Entity Address: 701 GATEWAY BLVD., SUITE 400 City: South San Francisco

City: SOUTH SAN FRANCISCO State: CA State: CA Zip: 94080


Legal Entity Name: SAN MATEO HEALTH COMMISSION

Contract Number: H7885 Organization Marketing Name: Health Plan of San Mateo

Parent Organization: Health Plan of San Mateo


HMO/HMOPOS Name: CareAdvntg Unit


CMS Region Responsible: San Francisco Fax: Enrollment: 9,936 Email: [email protected] Address:

701 Gateway Blvd., Suite 400 Legal Entity Address: 701 Gateway Blvd.

Suite 400 City: South San Francisco City: South San Francisco State: CA


Legal Entity Name: SAN YSIDRO HEALTH CENTER

Contract Number: H9616 Organization Marketing Name: San Diego PACE

Parent Organization: Centro de Salud de la Comunidad de

San Ysidro

Organization Type: National PACE Contact Title: Vice President of Senior Health Services Plan Type: National PACE Name: Rosana Scolari



Address: 1275 30th Street Legal Entity Address: 1275 30th Street

City: San Diego City: San Diego State: CA


Legal Entity Name: SANFORD HEART OF AMERICA

HEALTH PLAN Contract Number: H3503 Organization Marketing Name: Sanford Heart of America

Health Plan Parent Organization: Sanford Health Plan

Organization Type: 1876 Cost Contact Title: Director of Planning & Regulation Plan Type: 1876 Cost Name: Lisa M Carlson



Address: 300 Cherapa Place, Suite 201 Legal Entity Address: 300 Cherapa Place, #201 PO Box 91110

PO Box 91110 City: Sioux Falls City: Sioux Falls State: SD

State: SD Zip: 57109-1110 Zip: 57109 Last Updated: 02/03/2014

Legal Entity Name: SANTA CLARA COUNTY HEALTH

AUTHORITY Contract Number: H7890 Organization Marketing Name: Santa Clara Family Health Plan Cal

MediConnect


Parent Organization: SANTA CLARA COUNTY HEALTH

AUTHORITY





Address: 210 E. Hacienda Avenue Legal Entity Address: 210 E. Hacienda Avenue

City: Campbell City: Campbell State: CA


Legal Entity Name: SANTE FE EMPLOYEES HOSPITAL

ASSOCIATION Contract Number: H6053 Organization Marketing Name: Santa Fe Employes Hospital Assn. -

Coast Lines Parent Organization: Sante Fe Employees Hospital

Assn.

Organization Type: HCPP - 1833 Cost Contact Title: CEO Plan Type: HCPP - 1833 Cost Name: Cecil D Davis



Address: 551 E. San Bernardino Road, Legal Entity Address: 551 E. SAN BERNARDINO ROAD

City: Covina City: COVINA State: CA


Legal Entity Name: SCAN HEALTH PLAN Contract Number: H5425

Organization Marketing Name: SCAN Health

Plan Parent Organization: SCAN

Health Plan

Organization Type: Local CCP Contact Title: Director, Member Services Operations Plan Type: HMO/HMOPOS Name: Kim McBeath



Address: 3800 Kilroy Airport Way Legal Entity Address: 3800 Kilroy Aiport Way Suite 100

Suite 100 City: Long Beach City: Long Beach State: CA



Organization Marketing Name: VillageHealth Parent Organization: SCAN Health Plan

Organization Type: Local CCP Contact Title: Director, Member Services Operations Plan Type: HMO/HMOPOS Name: Kim McBeath




Address: 3800 Kilroy Airport Way Legal Entity Address: 3800 Kilroy Airport Way Suite 100

Suite 100 City: Long Beach City: Long Beach State: CA



Organization Marketing Name: SCAN Health

Plan Parent Organization: SCAN

Health Plan




Legal Entity Address: 3800 Kilroy Airport Way Suite 100


Zip:

90806

Contact Title: Manager, Member Services

Operations Name: Kim McBeath Phone: 1-800-559-3500


Email: [email protected] Address: 3800 Kilroy Airport Way

Suite 100 City: Long Beach

State: CA Zip: 90806


Legal Entity Name: SCOTT AND WHITE HEALTH PLAN

Contract Number: H4564 Organization Marketing Name: Scott and White Health Plan

SeniorCare Parent Organization: Baylor Scott & White

Holdings

Organization Type: 1876 Cost Contact Title: Call Center Plan Type: 1876 Cost Name: Customer Service



Address: 1206 West Campus Drive Legal Entity Address: 1206 West Campus Drive

City: Temple City: TEMPLE State: TX


Legal Entity Name: SECURITY HEALTH PLAN OF

WISCONSIN, INC. Contract Number: H5211 Organization Marketing Name: Security Health Plan of Wisconsin,

Inc. Parent Organization: Marshfield Clinic Health System, Inc.

Organization Type: Local CCP Contact Title: Customer Service Manager Plan Type: HMO/HMOPOS Name: April Bores



Address: 1515 Saint Joseph Avenue Legal Entity Address: 1515 SAINT JOSEPH AVENUE PO Box 8000

PO Box 8000 City: Marshfield City: MARSHFIELD State: WI

State: WI Zip: 54449-8000


Zip: 54449 Last Updated: 11/21/2013 Legal Entity Name: SECURITYCARE OF TENNESSEE,

INC. Contract Number: H8146 Organization Marketing Name: BlueChoice Tennessee

Parent Organization: BlueCross BlueShield of Tennessee

Organization Type: Local CCP Contact Title: Dir Product Strategy & Finance Plan Type: HMO/HMOPOS Name: Paul Farrell



Address: 1 Cameron Hill Circle Legal Entity Address: 1 Cameron Hill Circle



Legal Entity Name: SELECT HEALTH OF SOUTH

CAROLINA, INC. Contract Number: H8213 Organization Marketing Name: FIRST CHOICE VIP CARE

PLUS Parent Organization: Independence Blue

Cross

Organization Type: Demo Contact Title: Dir.,Medicare Member, Provider, Customer Service Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Geoffrey Vitrano



Address: Amerihealth Caritas Family of

Companies Legal Entity Address: 4930 Belle Oaks Drive 200 Stevens Dr

400 City: Philadelphia City: North Charleston State: PA


Legal Entity Name: SELECTCARE HEALTH PLANS, INC.

Contract Number: H5656 Organization Marketing Name: Universal American Corp. Parent

Organization: Universal American Corp.

Organization Type: Local CCP Contact Title: Member Services Representative Plan Type: HMO/HMOPOS Name: Member Services



Address: 4888 Loop Central Drive Legal Entity Address: 4888 Loop Central Drive Suite 300

Suite 300 City: Houston City: Houston State: TX


Legal Entity Name: SELECTCARE OF TEXAS, INC. Contract

Number: H4506 Organization Marketing Name: Universal American Corp. Parent

Organization: Universal American Corp.

Organization Type: Local CCP Contact Title: Member Services Representative Plan Type: HMO/HMOPOS Name: Member Services




Enrollment: 62,746 Email: [email protected] Address: 4888 Loop Central Drive

Legal Entity Address: 4888 Loop Central Drive Suite 300 Suite 300 City: Houston


Zip: 77081 Last Updated: 04/12/2013 Legal Entity Name: SELECTHEALTH, INC. Contract Number: H1994

Organization Marketing Name: SelectHealth Parent Organization: Intermountain Health Care, Inc.

Organization Type: Local CCP Contact Title: Director of Medicare Programs and Products Plan Type: HMO/HMOPOS Name: Mark Richardson



Address: 5381 S Green St Legal Entity Address: 5381 Green Street

City: Murray City: Murray State: UT


Legal Entity Name: SENIOR CARE CONNECTION, INC.

Contract Number: H3322 Organization Marketing Name: Eddy SeniorCare

Parent Organization: Senior Care Connection, Inc.




Legal Entity Address: 504 STATE STREET

City: SCHENECTADY State: NY Zip: 12305

Contact Title: VicePresident/Director Name:

Bernadette Hallam Phone: 1-518-382-3290 Extension: 6349


State Street

City: Schenectady State: NY


Legal Entity Name: SENIOR LIFE ALTOONA,

INC. Contract Number: H5902 Organization Marketing Name: Senior LIFE Ebensburg

Parent Organization: Senior LIFE Altoona, Inc.




Address: 401 Broad Street Legal Entity Address: 401 Broad Street

City: Johnstown City: Johnstown State: PA



Legal Entity Name: SENIOR LIFE

GREENSBURG, INC. Contract Number: H2937 Organization Marketing Name: Westmoreland county

PACE Parent Organization: Senior LIFE Greensburg,

Inc.




Address: 401 Broad Street Legal Entity Address: 401 Broad Street

City: Johnstown City: Johnstown State: PA


Legal Entity Name: SENIOR LIFE LEHIGH

VALLEY, INC. Contract Number: H5978 Organization Marketing Name: PHI LIFE dba everyday

LIFE Parent Organization: Senior LIFE Lehigh Valley,

Inc.







Legal Entity Name: SENIOR LIFE YORK, INC.

Contract Number: H0819 Organization Marketing Name: York County PACE

Parent Organization: Senior LIFE York, Inc.




Legal Entity Address: 1460 Memory Lane Ext.

City: York State: PA

Zip: 17402

Contact Title: Chief Executive Officer Name: Mark Irwin Phone: 1-814-535-6000 Extension:

101 Fax: 1-814-248-7902

Email: [email protected] Address:

401 Broad Street

City: Johnstown State: PA


Legal Entity Name: SENIOR TOTAL LIFE CARE, INC.

Contract Number: H4235 Organization Marketing Name: Senior Total Life Care Parent

Organization: CaroMont Health, Inc.

Organization Type: National PACE Contact Title: Executive Director


Plan Type: National PACE Name: Cathy Kenzig Contract Effective Date: 01/01/2014 Phone: 1-704-874-0603

Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Atlanta Fax:

Enrollment: 113 Email: [email protected] Address:

1875 Remount Rd. Legal Entity Address: 1875 Remount Road

City: Gastonia City: Gastonia State: NC


Legal Entity Name: SENIOR WHOLE HEALTH OF NEW

YORK, INC. Contract Number: H5992 Organization Marketing Name: Senior Whole Health of New

York Parent Organization: SWH Holdings, Inc.

Organization Type: Local CCP Contact Title: Chief Information Officer Plan Type: HMO/HMOPOS Name: Marie Maloney



Address: 58 Charles Street, 2nd Floor Legal Entity Address: 58 Charles Street, 2nd Floor

City: Cambridge City: Cambridge State: MA


Legal Entity Name: SENIOR WHOLE HEALTH OF NEW

YORK, INC. Contract Number: H8851 Organization Marketing Name: SWH Whole Health FIDA

Plan Parent Organization: SWH Holdings, Inc.

Organization Type: Demo Contact Title: Manager Marketing Plan Type: Medicare-Medicaid Plan

HMO/HMOPOS Name: Lynne Marshall



Address: 58 Charles Street, 2nd Floor Legal Entity Address: Trinity Center

111 Broadway Suite 1505 City: Cambridge City: New York State: MA


Legal Entity Name: SENIOR WHOLE HEALTH, LLC

Contract Number: H2224 Organization Marketing Name: Senior Whole Health Parent

Organization: SWH Holdings, Inc.



CMS Region Responsible: Boston Enrollment: 10,497

Legal Entity Address: 58 Charles Street, 2nd Floor

City: CAMBRIDGE State: MA

Contact Title: Chief Information Officer Name: Marie Maloney Phone: 1-617-494-5353 Extension: 6313


Charles Street, 2nd Floor

City: Cambridge State: MA



Zip: 02141

Legal Entity Name: SENIORLIFE WASHINGTON, INC.

Contract Number: H2992 Organization Marketing Name: Senior LIFE Washington / Uniontown /

Green Parent Organization: SeniorLife Washington, Inc.

Organization Type: National PACE Contact Title: Cheif Executive Officer Plan Type: National PACE Name: Mark Irwin






Legal Entity Name: SENTARA LIFE CARE CORPORATION,

INC Contract Number: H2941 Organization Marketing Name: Sentara PACE

Parent Organization: Sentara Health Care (SHC)

Organization Type: National PACE Contact Title: Program Director Plan Type: National PACE Name: Suzanne Coyner



Address: 251 S. Newtown Road Legal Entity Address: 251 S. NEWTOWN ROAD

City: Norfolk City: NORFOLK State: VA


Legal Entity Name: SERENITY CARE, INC. Contract Number: H0477

Organization Marketing Name: Serenity Care PACE Parent

Organization: Serenity Care, Inc.

Organization Type: National PACE Contact Title: Plan Type: National PACE Name: Bob Tannery


CMS Region Responsible: Boston Fax: Enrollment: 69 Email: [email protected] Address: P.O.Box

Legal Entity Address: P.O. Box 2006 City: Eau Claire

City: Andover State: WI State: MA Zip: 54702


Zip: 01810 Last Updated: 04/23/2013 Legal Entity Name: SHA, L.L.C Contract Number: H4525

Organization Marketing Name: FirstCare Advantage Parent Organization: Covenant Health - Hendrick Medical Center




Legal Entity Address: 12940 North Highway 183

City: Austin

State: TX Zip: 78750

Contact Title: Customer Service Name: Customer Service Phone: 1-866-229-4969


Email: [email protected] Address: 1901 West Loop 289, Suite 9

City: Lubbock State: TX


Legal Entity Name: SHARP HEALTH PLAN Contract Number: H5386

Organization Marketing Name: North County Select Parent Organization: Sharp Healthcare

Organization Type: Local CCP Contact Title: Vice President and Chief Operating Officer Plan Type: HMO/HMOPOS Name: Leslie Pels-Beck



Address: 8520 Tech Way Legal Entity Address: 8520 Tech Way Suite 200

Suite 200 City: San Diego City: San Diego State: CA


Legal Entity Name: SIDNEY HILLMAN HC Contract Number: H6141

Organization Marketing Name: Sidney Hillman HC Parent Organization: Sidney Hillman Health Center (SHHC)

Organization Type: HCPP - 1833 Cost Contact Title: Operations Director Plan Type: HCPP - 1833 Cost Name: Adriana Medina



Address: 333 S. Ashland Legal Entity Address: 333 SOUTH ASHLAND AVENUE

City: Chicago City: CHICAGO State: IL


Legal Entity Name: SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. Contract Number: H2001 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 9900 Bren Road E

City: Hot Springs City: Minnetonka State: AR State: MN Zip: 71903 Zip: 55343 Last Updated: 11/24/2010

Legal Entity Name: SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. Contract Number: H2406 Organization Marketing Name: UnitedHealthcare



Contract Effective Date: 06/01/2001 Phone: 1-877-842-3210 Tax Status: For Profit Extension: CMS Region Responsible: San Francisco Fax: Enrollment: 817 Email: [email protected]

Address: P.O. Box 29675 Legal Entity Address: 9900 BREN ROAD EAST

MN008-W130 City: Hot Springs City: MINNETONKA State: AR State: MN Zip: 71903 Zip: 55343 Last Updated: 11/24/2010

Legal Entity Name: SIERRA HEALTH AND LIFE INSURANCE COMPANY,

INC. Contract Number: H2905 Organization Marketing Name: Sierra Health and Life Insurance Company, Inc.

Parent Organization: UnitedHealth Group, Inc. Organization Type: Local CCP Contact Title: Director, Government Programs/Member Services Plan Type: Local PPO Name: David Stuczynski


Extension: CMS Region Responsible: San Francisco Fax: 1-702-869-2484 Enrollment: 3,505 Email: [email protected]

Address: 2720 N. Tenaya Way Legal Entity Address: 2724 N. Tenaya Way

City: Las Vegas City: Las Vegas State: NV State: NV Zip: 89128 Zip: 89128 Last Updated: 06/09/2009

Legal Entity Name: SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. Contract Number:

H5652 Organization Marketing Name: Erickson Advantage





Address: P.O. Box 29675 Legal Entity Address: 9900 Bren Road East


Legal Entity Name: SIMPLY HEALTHCARE

PLANS, INC. Contract Number: H5471 Organization Marketing Name: Simply Healthcare Plans,

Inc. Parent Organization: Anthem Inc.

Organization Type: Local CCP Contact Title: Vice President of Member Services Plan Type: HMO/HMOPOS Name: Irene Ferro



Address: 1701 Ponce de Leon Blvd Legal Entity Address: 1701 Ponce de Leon Blvd. Suite 300

Suite 300 City: Coral Gables City: Coral Gables State: FL


Legal Entity Name: SIOUXLAND PACE, INC.

Contract Number: H8424 Organization Marketing Name: SIOUXLAND PACE, INC.

Parent Organization: St. Luke's Health System,

Inc.

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Randall S Ehlers


CMS Region Responsible: Kansas City Fax: 1-712-224-7253 Enrollment: 134 Email: [email protected]

Address: 309 Cook St Legal Entity Address: 309 Cook St

City: Sioux City City: Sioux City State: IA


Legal Entity Name: SOUNDPATH HEALTH Contract Number: H9302

Organization Marketing Name: Soundpath Health Parent Organization: Catholic Health Initiatives



CMS Region Responsible: Denver Fax: 1-253-779-8829 Enrollment: 21,033 Email: [email protected] Address:

32129 Weyerhaeuser Way S., Suite 201


Legal Entity Address: 32129 Weyerhaeuser Way S Suite 201 City: Federal Way

City: Federal Way State: WA State: WA Zip: 98001

Zip: 980019911 Last Updated: 02/25/2015 Legal Entity Name: SOUTH COUNTRY HEALTH

ALLIANCE Contract Number: H2419 Organization Marketing Name: South Country Health

Alliance Parent Organization: South Country Health

Alliance




Address: 2300 Park Drive, Suite 100 Legal Entity Address: 2300 Park Drive

Suite 100 City: Owatonna City: OWATONNA State: MN


Legal Entity Name: SOUTH COUNTRY HEALTH

ALLIANCE Contract Number: H5703 Organization Marketing Name: South Country Health

Alliance Parent Organization: South Country Health

Alliance




Address: 2300 Park Drive, Suite 100 Legal Entity Address: 2300 Park Drive

Suite 100 City: Owatonna City: Owatonna State: MN


Legal Entity Name: SOUTH JERSEY HEALTHCARE

LIFE, INC. Contract Number: H6887 Organization Marketing Name: Inspira Health Network LIFE

Parent Organization: South Jersey Health System, Inc.




Legal Entity Address: 2445 Delsea Drive

City: Vineland State: NJ

Zip: 08360

Contact Title: Director of Finance Name: Dana Palma Phone: 1-856-362-4516


Email: [email protected] Address: 2445 Delsea Drive

City: Vineland State: NJ



Legal Entity Name: SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION Contract

Number: H5580 Organization Marketing Name: Mercy Care Advantage

Parent Organization: Southwest Catholic Health Network Organization Type: Local CCP Contact Title: Director, Customer and Enrollment Services Plan Type: HMO/HMOPOS Name: Cathy Waldbillig



Address: 4350 E Cotton Center Boulevard Legal Entity Address: 4350 E Cotton Center Boulevard Bldg D Bldg D City: Phoenix City: Phoenix State: AZ State: AZ Zip: 85040 Zip: 85040 Last Updated: 07/21/2014

Legal Entity Name: SPIRITTRUST LUTHERAN

LIFE Contract Number: H2537 Organization Marketing Name: SpiriTrust Lutheran

LIFE Parent Organization: SpiritTrust

Lutheran

Organization Type: National PACE Contact Title: VP Community Health Services Plan Type: National PACE Name: Terry Shade



Address: 2700 Luther Drive Legal Entity Address: 840 Fifth Avenue, Chambersburg,

PA 17201 1920 Good Hope Road,

Enola, PA 17025-1235 City: Chambersburg City: Chambersburg State: PA


Legal Entity Name: ST. AGNES CONTINUING CARE

CENTER Contract Number: H3919 Organization Marketing Name: Mercy LIFE


Organization Type: National PACE Contact Title: Account Representative Plan Type: National PACE Name: Kim Brewington



Address: 1930 S. Broad St. Legal Entity Address: 1930 South Broad Street

City: Philadelphia City: PHILADELPHIA State: PA


Legal Entity Name: STABLEVIEW HEALTH Contract Number: H9492

Organization Marketing Name: StableView Health Parent Organization: Catholic Health Initiatives





Legal Entity Address: 1733 Harrodsburg Rd Ste 220

City: Lexington State: KY

Zip: 40504

Contact Title: VP, Medicare Advantage Sales & Marketing

Name: Kim Heuss Phone: 1-253-345-5555 Extension: 4305


Address: 32129 Weyerhaeuser Way S., Suite 201

City: Federal Way State: WA


Legal Entity Name: STAYWELL SENIOR CARE, INC. Contract

Number: H1533 Organization Marketing Name: StayWell Senior Care

Parent Organization: Randolph Hospital, Inc.

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Tracey Murphy


CMS Region Responsible: Atlanta Fax: 1-336-628-4235 Enrollment: 40 Email: [email protected] Address: 809

Curry Dr. Legal Entity Address: 809 Curry Dr.

City: Asheboro City: Asheboro State: NC


Legal Entity Name: SUMMACARE INC. Contract

Number: H3660 Organization Marketing Name: SummaCare Medicare Advantage Plans

Parent Organization: Summa Health System

Organization Type: Local CCP Contact Title: Provider Services Plan Type: HMO/HMOPOS Name: Donna Rank



Address: 10 North Main Street Legal Entity Address: P. O. Box 3620 10 North

Main Steet City: Akron City: AKRON State: OH


Legal Entity Name: SUNCOAST PACE, INC. Contract Number: H3430

Organization Marketing Name: Suncoast PACE, Inc. Parent Organization: The Hospice of the Florida Suncoast, Inc.

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Stephanie Sessions



Address: 5771 Roosevelt Blvd Legal Entity Address: 5771 Roosevelt Blvd.

City: Clearwater City: Clearwater State: FL



Legal Entity Name: SUNSHINE STATE HEALTH PLAN, INC.

Contract Number: H5190 Organization Marketing Name: Sunshine Health





Legal Entity Address: 1301 International Pkwy Suite 400

City: Sunrise State: FL

Zip: 33323



Address: 1301 International Parkway Suite 400

City: Sunrise State: FL


Legal Entity Name: SUPERIOR HEALTH PLAN, INC.

Contract Number: H5294 Organization Marketing Name: Superior HealthPlan


Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Provider Services



Address: 7700 Forsyth Blvd Legal Entity Address: The Regency Building, Suite 200

2100 South IH-35 City: St. Louis City: Austin State: MO


Legal Entity Name: SUPERIOR HEALTH PLAN, INC.

Contract Number: H6870 Organization Marketing Name: Superior HealthPlan


Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Member Services



Address: 2100 South IH - 35 Legal Entity Address: 2100 South IH-35 Suite 200

Suite 202 City: Austin City: Austin State: TX


Legal Entity Name: SUTTER HEALTH SACRAMENTO

SIERRA REGION Contract Number: H5406 Organization Marketing Name: Sutter SeniorCare PACE

Parent Organization: Sutter Health Sacramento Sierra Region

Organization Type: National PACE Contact Title: Center Manager Plan Type: National PACE Name: Sharon Boyd




Address: 7000 Franklin Blvd Ste

1020 Legal Entity Address: 7000 Franklin Blvd., Suite 1020

City: Sacramento City: Sacramento State: CA


Legal Entity Name: THE CONTRA COSTA HEALTH PLAN

Contract Number: H0502 Organization Marketing Name: Contra Costa Health Plan

Parent Organization: Contra Costa Health Services




Legal Entity Address: 595 CENTER AVENUE STE 100

City: MARTINEZ State: CA Zip: 94553

Contact Title: Sales and Outreach Manager Name: Wendy Mailer Phone: 1-925-957-7224 Extension:

Fax: 1-925-313-6065 Email: [email protected] Address:

595 Center Ave. Ste. 100

City: Martinez State: CA


Legal Entity Name: THE JOHNS HOPKINS HEALTH SYSTEM

CORPORATION Contract Number: H2109 Organization Marketing Name: Hopkins ElderPlus

Parent Organization: The Johns Hopkins Health System Corporation Organization Type: National PACE Contact Title: Director Plan Type: National PACE Name: Jonathan Aistrop

Contract Effective Date: 11/01/2002 Phone: 1-410-550-7044 Tax Status: Not-for-Profit/Non-

Profit Extension: CMS Region Responsible: Philadelphia Fax: 1-410-550-7045 Enrollment: 143 Email: [email protected]

Address: 4940 Eastern Avenue, Mason Lord Bldg., East Tower, First Floor Legal Entity Address: 4940 EASTERN AVENUE

MASON LORD BLDG.,EAST TOWER 1ST FLR City: Baltimore City: BALTIMORE State: MD State: MD Zip: 21224 Zip: 21224 Last Updated: 01/31/2013

Legal Entity Name: THE LUTHERAN HOME FOR THE

AGED Contract Number: H4999 Organization Marketing Name: LIFE Northwestern Pennsylvania

Parent Organization: The Lutheran Home for The Aged

Organization Type: National PACE Contact Title: CEO Plan Type: National PACE Name: Mark J Gusek



Address: LIFE-NWPA -- MED-D Administration Legal Entity Address: 149 West 22nd Street 149 West 22nd St. City:

Erie City: Erie State: PA



Legal Entity Name: THE METHODIST OAKS Contract Number: H0105

Organization Marketing Name: The Methodist Oaks d.b.a. The

Oaks PACE Parent Organization: The Methodist Oaks

Organization Type: National PACE Contact Title: Business Office Manager Plan Type: National PACE Name: Deborah Hair



Address: P.O.Drawer 327 Legal Entity Address: 153 Founders Ct

Orangeburg City: Orangeburg City: Orangeburg State: SC


Legal Entity Name: THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC. Contract

Number: H1916 Organization Marketing Name: Fidelis Care

Parent Organization: The New York State Catholic Health Plan, Inc. Organization Type: Demo Contact Title: Vice President, Member Services & Enrollment Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Brian Cummings Contract Effective Date: 01/01/2015 Phone: 1-800-247-1447 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: New York Fax: Enrollment: 403 Email: [email protected]

Address: 95-25 Queens Boulevard Legal Entity Address: 95-26 Queens Boulevard

City: Rego Park City: Rego Park State: NY State: NY Zip: 11374 Zip: 11374 Last Updated: 04/08/2013

Legal Entity Name: THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC. Contract

Number: H3328 Organization Marketing Name: Fidelis Care

Parent Organization: The New York State Catholic Health Plan, Inc. Organization Type: Local CCP Contact Title: Vice President, Member Services & Enrollment Plan Type: HMO/HMOPOS Name: Brian Cummings


Extension: CMS Region Responsible: New York Fax: Enrollment: 41,447 Email: [email protected]

Address: 95-25 Queens Boulevard Legal Entity Address: 95-25 QUEENS BOULEVARD

City: Rego Park City: REGO PARK State: NY State: NY Zip: 11374 Zip: 11374 Last Updated: 04/08/2013

Legal Entity Name: THE WASHTENAW PACE

Contract Number: H4118 Organization Marketing Name: Huron Valley PACE

Parent Organization: Utd Methodist Retirement

Communities of SE MI

Organization Type: National PACE Contact Title: Executive Director Plan Type: National PACE Name: Rick Bluhm



Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Chicago Fax:

Enrollment: 68 Email: [email protected] Address: 2940 Ellsworth

Legal Entity Address: 2940 Ellsworth Rc. City: Ypsilanti

City: Ypsilanti State: MI State: MI Zip: 48197

Zip: 48197 Last Updated: 07/19/2013 Legal Entity Name: THP INSURANCE COMPANY

Contract Number: H8604 Organization Marketing Name: Health Plan SecureChoice

Parent Organization: Health Plan of the Upper Ohio

Valley

Organization Type: Local CCP Contact Title: Director Member Services Plan Type: Local PPO Name: Sherry Stanley


CMS Region Responsible: Philadelphia Fax: 1-740-695-8103 Enrollment: 691 Email: [email protected] Address:

The Health Plan Legal Entity Address: 52160 National Road East 52160 National Road East City: St.

Clairsville City: St. Clairsville State: OH


Legal Entity Name: TOTAL COMMUNITY CARE, L.L.C.

Contract Number: H5213 Organization Marketing Name: InnovAge Greater New Mexico

PACE Parent Organization: Total Community Options, Inc.



CMS Region Responsible: Dallas Enrollment: 374

Legal Entity Address: 904 LAS LOMAS N.E.

City: Albuquerque State: NM

Zip: 87102

Contact Title: Vice President of Marketing

Name: Elizabeth Moroney Phone: 1-303-869-4664 Extension:

Fax: 1-303-996-1600 Email: [email protected] Address:

8950 East Lowry Boulevard

City: Denver State: CO


Legal Entity Name: TOTAL LIFE HEALTHCARE

Contract Number: H4305 Organization Marketing Name: Total Life Healthcare

Parent Organization: St. Bernard's Healthcare

Organization Type: National PACE Contact Title: Finance Manager Plan Type: National PACE Name: Terry Combs


CMS Region Responsible: Dallas Fax: 1-870-207-0527 Enrollment: 160 Email: [email protected] Address: 225

East Jackson #92 Legal Entity Address: 225 East Jackson #92

505 E. Matthews City: Jonesboro City: Jonesboro State: AR



Legal Entity Name: TOTAL LONGTERM CARE, INC.

Contract Number: H0613 Organization Marketing Name: InnovAge

Parent Organization: Total Community Options, Inc.

Organization Type: National PACE Contact Title: Vice President of Marketing Plan Type: National PACE Name: Elizabeth Moroney



Address: 8950 East Lowry Boulevard Legal Entity Address: 8950 E. Lowry Blvd.

City: Denver City: DENVER State: CO


Legal Entity Name: TOTAL LONGTERM CARE, INC.

Contract Number: H6079 Organization Marketing Name: InnovAge Greater California

PACE Parent Organization: Total Community Options,

Inc.

Organization Type: National PACE Contact Title: Vice President of Marketing Plan Type: National PACE Name: Elizabeth Moroney



Address: 8950 East Lowry Boulevard Legal Entity Address: 410 E. Parkcenter Circle North

City: Denver City: San Bernadino State: CO


Legal Entity Name: TOTAL SENIOR CARE, INC.

Contract Number: H8800 Organization Marketing Name: Total Senior Care, Inc.

Parent Organization: Community Care of Western

New York, Inc.




Legal Entity Address: 519 North Union St

City: Olean State: NY

Zip:

14760

Contact Title: Program Officer

Name: Ann Feightner Phone: 1-716-379-8474



Address: 519 North Union Street

City: Olean State: NY


Legal Entity Name: TOUCHSTONE HEALTH

HMO, INC. Contract Number: H3327 Organization Marketing Name: Touchstone Health

Parent Organization: Touchstone Health

Partnership, Inc


Organization Type: Local CCP Contact Title: Vice President, Marketing Plan Type: HMO/HMOPOS Name: Laura Dechen



Address: One North Lexington Avenue Legal Entity Address: One North Lexington Avenue 12th Floor

12th floor City: White Plains City: White Plains State: NY


Legal Entity Name: TRILLIUM COMMUNITY

HEALTH PLAN Contract Number: H2174 Organization Marketing Name: Trillium Advantage

Parent Organization: Agate Resources, Inc.

Organization Type: Local CCP Contact Title: Chief Administrative Officer Plan Type: HMO/HMOPOS Name: Shannon D Conley



Address: 1800 Millrace Drive Legal Entity Address: 1800 Millrace Drive

City: Eugene City: Eugene State: OR


Legal Entity Name: TRILLIUM COMMUNITY

HEALTH PLAN Contract Number: H6951 Organization Marketing Name: Trillium Advantage

Parent Organization: Agate Resources, Inc.

Organization Type: Local CCP Contact Title: Chief Administrative Officer Plan Type: Local PPO Name: Shannon D Conley


CMS Region Responsible: Seattle Fax: 1-541-434-1067 Enrollment: 384 Email: [email protected]

Address: 1800 Millrace Drive Legal Entity Address: 1800 Millrace Drive

City: Eugene City: Eugene State: OR


Legal Entity Name: TRIPLE S ADVANTAGE, INC.

Contract Number: H5774 Organization Marketing Name: Triple S Advantage

Parent Organization: Triple-S Management

Corporation





Legal Entity Address: PO Box 11320


Zip: 00922

Contact Title: Sales & Marketing VP

Name: Gustavo Perez Phone: 1-787-620-1919

Extension: 4131 Fax: Email: [email protected]




Legal Entity Name: TRIPLE-S ADVANTAGE, INC. Contract

Number: H4005 Organization Marketing Name: Triple-S Advantage

Parent Organization: Triple-S Management Corporation

Organization Type: Local CCP Contact Title: Sales & Marketing VP Plan Type: Local PPO Name: Gustavo Perez


CMS Region Responsible: New York Fax: Enrollment: 17,578 Email: [email protected] Address: PO Box

11320 Legal Entity Address: PO BOX 11320

City: San Juan City: SAN JUAN State: PR


Legal Entity Name: TRUSTEES OF THE UNIVERSITY OF

PENNSYLVANIA Contract Number: H3908 Organization Marketing Name: Trustees Of The University Of

Pennsylvania Parent Organization: Trustees of the University of Pennsylvania

Organization Type: National PACE Contact Title: Chief Executive Officer Plan Type: National PACE Name: Anthony Buividas



Address: 4508 Chestnut Street Legal Entity Address: 4508 CHESTNUT STREET

City: Philadelphia City: PHILADELPHIA State: PA


Legal Entity Name: TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION Contract Number:

H2256 Organization Marketing Name: Tufts Health Plan or Tufts Medicare Preferred Parent

Organization: Tufts Associated HMO, Inc.


Organization Type: Local CCP Contact Title: Supervisor, Marketing Material Production Plan Type: HMO/HMOPOS Name: Kenneth Kayser Contract Effective Date: 07/01/1994 Phone: 1-617-972-9400 Tax Status: Not-for-Profit/Non-Profit Extension: 9527 CMS Region Responsible: Boston Fax: Enrollment: 104,870 Email: [email protected]

Address: 705 Mt Auburn St Legal Entity Address: 705 Mt Auburn Street

City: Watertown City: Watertown State: MA State: MA Zip: 02472 Zip: 02472 Last Updated: 09/09/2013

Legal Entity Name: TUFTS HEALTH PUBLIC PLANS, INC.

Contract Number: H7419 Organization Marketing Name: Tufts Health Plan - Network Health

Parent Organization: Tufts Associated HMO, Inc.

Organization Type: Demo Contact Title: Marketing Speciialst Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Elane Tohmc



Address: 101 Station Landing Legal Entity Address: 101 Station Landing 4th Floor

4th Floor City: Medford City: Medford State: MA


Legal Entity Name: UCARE MINNESOTA Contract Number: H2456

Organization Marketing Name: UCare's MSHO Parent Organization: UCare Minnesota




Legal Entity Address: 500 Stinson Blvd NE


Zip: 55413

Contact Title: Name: Provider Assistance Phone: 1-888-531-1493


[email protected]

Address: 500 Stinson Boulevard NE



Legal Entity Name: UCARE MINNESOTA Contract Number: H2459

Organization Marketing Name: UCare Parent Organization: UCare Minnesota





Legal Entity Address: 500 Stinson Boulevard

NE


Zip: 55413

Contact Title: Name: Provider Assistance Phone: 1-888-531-1493


[email protected]

Address: 500 Stinson Boulevard NE



Legal Entity Name: UHC OF CALIFORNIA Contract Number: H0543

Organization Marketing Name: UnitedHealthcare Parent Organization: UnitedHealth Group, Inc.




Legal Entity Address: 5995 PLAZA DRIVE

City: CYPRESS State: CA Zip:

90630



P.O. Box 29675



Legal Entity Name: ULTIMATE HEALTH

PLANS, INC. Contract Number: H2962 Organization Marketing Name: Ultimate Health Plans

Parent Organization: ULTIMATE HEALTH

PLAN, INC.




Legal Entity Address: 1244 Mariner Boulevard

City: Spring Hill State: FL

Zip: 34609

Contact Title: CEO Name: Mike Turrell Phone: 1-352-835-7151



Address: 1244 Mariner Blvd.

City: Spring Hill State: FL


Legal Entity Name: UNION HEALTH SERVICES, INC.

Contract Number: H6142 Organization Marketing Name: Union Health Service, Inc.

Parent Organization: Union Health Services, Inc.

Organization Type: HCPP - 1833 Cost Contact Title: No contact data submitted Plan Type: HCPP - 1833 Cost Name:

Contract Effective Date: 02/01/1983 Phone: Tax Status: Not-for-Profit/Non-Profit Extension:

CMS Region Responsible: Chicago Fax: Enrollment: 1,825 Email: Address:


Legal Entity Address: 1634 WEST POLK STREET City:

City: CHICAGO State: State: IL Zip:

Zip: 60612 Last Updated: Legal Entity Name: UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS Contract Number:

H4652 Organization Marketing Name: Union Pacific Railroad Employes Health Systems Parent Organization:

Union Pacific Railroad Employes Health Systems Organization Type: HCPP - 1833 Cost Contact Title: Manager of Customer Services Plan Type: HCPP - 1833 Cost Name: Tonya Hayes

Contract Effective Date: 12/01/1993 Phone: 1-801-595-4387 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Denver Fax: 1-801-595-2087 Enrollment: 11,809 Email: [email protected]

Address: 1040 N 2200 W Suite 200 Legal Entity Address: 1040 North 2200 West Suite 200

City: Salt Lake City City: Salt Lake City State: UT State: UT Zip: 84116 Zip: 84116 Last Updated: 02/02/2015

Legal Entity Name: UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT Contract Number: 90091 Organization Marketing Name: United Mine Workers of America Health & Retirement Parent Organization:

UMWA Health and Retirement Funds

Organization Type: HCPP - 1833 Cost Contact Title: Plan Type: HCPP - 1833 Cost Name: Health Call Center

Contract Effective Date: 02/01/1974 Phone: 1-800-291-1425 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Philadelphia Fax: 1-304-256-2626 Enrollment: 24,360 Email: [email protected]

Address: P.O. Box 2320 Legal Entity Address: 2121 K

STREET, N.W. SUITE 350 City: Beckley City: WASHINGTON State: WV State: DC Zip: 25802 Zip: 20037 Last Updated: 04/24/2009

Legal Entity Name: UNITEDHEALTHCARE BENEFITS OF

TEXAS, INC. Contract Number: H4590 Organization Marketing Name: UnitedHealthcare





Legal Entity Address: 8200 IH-10 SUITE 1000

City: SAN ANTONIO State: TX

Zip: 78230






Legal Entity Name: UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC. Contract Number: H2531

Organization Marketing Name: UnitedHealthcare Community Plan Parent Organization:

UnitedHealth Group, Inc.


Organization Type: Demo Contact Title: Customer Service Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Great Lakes Health Plan


Address: 26957 Northwestern Hwy Legal Entity Address: 9200 Worthington Road Suite 400

City: Southfield City: Westerville State: MI State: OH Zip: 48033 Zip: 43082 Last Updated: 08/13/2014

Legal Entity Name: UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC Contract Number: H4514 Organization Marketing Name: UnitedHealthcare





MN 008-W130 City: Hot Springs City: MINNETONKA State: AR State: MN Zip: 71903 Zip: 55343 Last Updated: 11/24/2010

Legal Entity Name: UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC Contract Number: H7833 Organization Marketing Name: UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC Parent

Organization: UnitedHealth Group, Inc.

Organization Type: Demo Contact Title: Customer Service Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Great Lakes Health Plan


Address: 26957 Northwestern Hwy Legal Entity Address: 9702 Bissonnett Street Suite 400 Suite 2200W City: Southfield City: Houston State: MI State: TX Zip: 48033 Zip: 77036 Last Updated: 08/13/2014

Legal Entity Name: UNITEDHEALTHCARE INSURANCE






Legal Entity Address: 9900 Bren Road East MN008-T440

City: Minnetonka State: MN







Zip: 55343








MN008-W130 City: Hot Springs City: MINNETONKA State: AR


















MN008-T440 City: Hot Springs City: Minnetonka State: AR

State: MN Zip: 71903


Zip: 55343 Last Updated: 11/23/2010 Legal Entity Name: UNITEDHEALTHCARE INSURANCE


Community Plan Parent Organization: UnitedHealth

Group, Inc.




Legal Entity Address: 9900 BREN ROAD EAST

City: MINNETONKA State: MN

Zip: 55343

Contact Title: Customer Service

Name: Great Lakes Health

Plan Phone: 1-888-903-


Address: 26957 Northwestern Hwy Suite 400

City: Southfield State: MI


















City: Hot Springs City: MINNETONKA State: AR





Organization Type: PFFS Contact Title: Plan Type: PFFS Name: Customer Service





MN008-T615 City: Hot Springs City: Minnetonka State: AR








Legal Entity Address: 9900 Bren Rd East MN008-T440


Zip: 55343












Address: P.O. Box 29675 Legal Entity Address: c/o UnitedHealth Group/Ovations, 9900

Bren Rd East MAIL ROUTE MN0008-W240 City: Hot Springs

City: Minnetonka State: AR State: MN Zip: 71903

Zip: 55343 Last Updated: 11/24/2010 Legal Entity Name: UNITEDHEALTHCARE INSURANCE

COMPANY Contract Number: R3175 Organization Marketing Name: UnitedHealthcare


Organization Type: Regional CCP Contact Title: Plan Type: Regional PPO Name: Customer Service




City: Hot Springs City: Minnetonka State: AR










City: Hot Springs City: Minnetonka State: AR








Address: P.O. Box 29675 Legal Entity Address: c/o UnitedHealth Group/Ovations, 9900

Bren Rd East MAIL ROUTE MN008-W240 City: Hot Springs

City: Minnetonka State: AR State: MN Zip: 71903


Legal Entity Name: UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK Contract Number:

H1537 Organization Marketing Name: UnitedHealthcare


Contract Effective Date: 01/01/2012 Phone: 1-877-842-3210 Tax Status: For Profit Extension: CMS Region Responsible: San Francisco Fax: Enrollment: 771 Email: [email protected]

Address: P.O. Box 29675 Legal Entity Address:

UnitedHealthcare Lockbox 5818 City: Hot Springs City: Carol Stream State: AR State: IL Zip: 71903 Zip: 601975818 Last Updated: 02/22/2011

Legal Entity Name: UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK Contract Number:

R5342 Organization Marketing Name: UnitedHealthcare







Legal Entity Name: UNITEDHEALTHCARE OF

ALABAMA, INC. Contract Number: H0151 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 13621 NW 12TH ST

City: Hot Springs City: SUNRISE State: AR



GEORGIA, INC. Contract Number: H1111 Organization Marketing Name: UnitedHealthcare





Legal Entity Address: 9900 Bren Road E


Zip: 55343






Legal Entity Name: UNITEDHEALTHCARE OF NEW

ENGLAND, INC. Contract Number: H1944 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 9900 Bren Road

East Mail Route MN-

008 W140 City: Hot Springs City: Minnetonka State: AR




YORK, INC. Contract Number: H3379 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 3803 N ELM ST

City: Hot Springs City: GREENSBORO State: AR



YORK, INC. Contract Number: H3387 Organization Marketing Name: UnitedHealthcare Community

Plan Parent Organization: UnitedHealth Group, Inc.

Organization Type: Local CCP Contact Title: Customer Service Plan Type: HMO/HMOPOS Name: Great Lakes Health Plan



Address: 26957 Northwestern Hwy Legal Entity Address: 7 HANOVER SQUARE Suite 400

5TH FLOOR City: Southfield City: NEW YORK State: MI



OKLAHOMA, INC. Contract Number: H3749 Organization Marketing Name: UnitedHealthcare





Legal Entity Address: 7666 E 61ST, #500

City: TULSA State: OK

Zip: 74133






Legal Entity Name: UNITEDHEALTHCARE OF OREGON,

INC. Contract Number: H3805 Organization Marketing Name: UnitedHealthcare






Address: P.O. Box 29675 Legal Entity Address: 7525 S.E. 24TH STREET

City: Hot Springs City: MERCER ISLAND State: AR


Legal Entity Name: UNITEDHEALTHCARE OF THE

MIDLANDS, INC. Contract Number: H2802 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 13655 RIVERPORT DRIVE

City: Hot Springs City: MARYLAND HEIGHTS State: AR


Legal Entity Name: UNITEDHEALTHCARE OF THE

MIDWEST, INC. Contract Number: H2654 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 13655 RIVERPORT DRIVE

City: Hot Springs City: MARYLAND HEIGHTS State: AR State: MO Zip: 71903

Zip: 63043 Last Updated: 11/24/2010 Legal Entity Name: UNITEDHEALTHCARE OF UTAH,

INC. Contract Number: H4604 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 2795 EAST COTTONWOOD

PARKWAY #200 City: Hot Springs City: SALT LAKE CITY State: AR




WISCONSIN, INC. Contract Number: H5253 Organization Marketing Name: UnitedHealthcare





Address: P.O. Box 29675 Legal Entity Address: 10701 W. RESEARCH DRIVE

P.O. BOX 26649 City: Hot Springs City: MILWAUKEE State: AR


Legal Entity Name: UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. Contract Number:

H0251 Organization Marketing Name: UnitedHealthcare Community Plan Parent Organization:

UnitedHealth Group, Inc. Organization Type: Local CCP Contact Title: Customer Service Plan Type: HMO/HMOPOS Name: Great Lakes Health Plan


Address: 26957 Northwestern Hwy Legal Entity Address: 1300 River Drive, Suite 200 Suite 400

City: Southfield City: Moline State: MI State: IL Zip: 48033 Zip: 61265 Last Updated: 08/13/2014

Legal Entity Name: UNIVERSAL CARE, INC. Contract Number: H0838

Organization Marketing Name: Brand New Day Parent Organization: Universal Care, Inc

Organization Type: Local CCP Contact Title: Executive Vice President / Compliance Officer Plan Type: HMO/HMOPOS Name: Connie Snyder


CMS Region Responsible: San Francisco Fax: 1-657-400-1212 Enrollment: 8,115 Email: [email protected] Address:

5455 Garden Grove Blvd. Legal Entity Address: 5455 Garden Grove Blvd Suite 500

Suite 500 City: Westminster City: Westminster State: CA


Legal Entity Name: UNIVERSITY CARE ADVANTAGE,

INC. Contract Number: H4931 Organization Marketing Name: University Care Advantage

Parent Organization: Banner Health





Legal Entity Address: 2701 E. Elvira

City: Tucson State: AZ

Zip: 85756

Contact Title: UCA Customer Care

Name: Customer Care Phone: 1-877-874-3930



Address: 2701 E. Elvira Rd

City: Tucson State: AZ


Legal Entity Name: UNIVERSITY HEALTHCARE

ADVANTAGE Contract Number: H2986 Organization Marketing Name: Stanford Health Care

Advantage Parent Organization: Stanford Health Care

Organization Type: Local CCP Contact Title: Manager Member Services Plan Type: HMO/HMOPOS Name: Sergio Cruz



Address: 899 Northgate Drive, Suite 530 Legal Entity Address: P.O. Box 72530

City: San Rafael City: Oakland State: CA


Legal Entity Name: UPHAMS CORNER HEALTH

COMMITTEE, INC. Contract Number: H2220 Organization Marketing Name: Uphams Corner Health

Committee, Inc. Parent Organization: Uphams Corner

Health Committee, Inc.

Organization Type: National PACE Contact Title: Director of Operations Plan Type: National PACE Name: Jagdeep Trivedi



Address: 1140 Dorchester Ave. Legal Entity Address: 500 Columbia Road

Mail Stop 1140-08 City: Dorchester City: DORCHESTER State: MA


Legal Entity Name: UPMC FOR YOU, INC Contract Number: H4279

Organization Marketing Name: UPMC for You Parent Organization: UPMC Health System

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Medicare Marketing


CMS Region Responsible: Philadelphia Fax: Enrollment: 19,702 Email: [email protected] Address: USX Tower,

9th Floor Legal Entity Address: USX Tower, 55th Floor 600 Grant Street

600 Grant Street City: Pittsburgh City: Pittsburgh State: PA



Legal Entity Name: UPMC HEALTH NETWORK, INC.

Contract Number: H5533 Organization Marketing Name: UPMC Health Plan


Organization Type: Local CCP Plan

Type: Local PPO Contract Effective Date:



Legal Entity Address: USX Tower, 55th Floor 600 Grant Street City:


Zip: 15219

Contact Title: Name: Medicare Marketing Phone: 1-877-381-3765


Address: USX Tower, 9th Floor 600 Grant Street City:



Legal Entity Name: UPMC HEALTH PLAN, INC. Contract

Number: H3907 Organization Marketing Name: UPMC Health Plan


Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Medicare Marketing


CMS Region Responsible: Philadelphia Fax: Enrollment: 116,340 Email: [email protected] Address: USX Tower,

9th Floor Legal Entity Address: USX Tower, 55th Floor 600 Grant Street

600 Grant Street City: Pittsburgh City: PITTSBURGH State: PA


Legal Entity Name: UPPER PENINSULA HEALTH PLAN,

LLC Contract Number: H1977 Organization Marketing Name: Upper Peninsula Health Plan (UPHP)

MI Health Link Parent Organization: DLP Marquette General

Hospital, LLC

Organization Type: Demo Contact Title: Director of Government Programs Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Melissa Holmquist



Address: UPHP Legal Entity Address: 228 W. Washington Street 228 W. Washington Street

City: Marquette City: Marquette State: MI


Legal Entity Name: UPPER PENINSULA HEALTH PLAN,

LLC Contract Number: H2161 Organization Marketing Name: Upper Peninsula Health Plan

Parent Organization: DLP Marquette General Hospital, LLC

Organization Type: Local CCP Contact Title: Director of Government Programs Plan Type: HMO/HMOPOS Name: Melissa Holmquist



Tax Status: For Profit Extension: CMS Region Responsible: Chicago Fax: 1-906-225-8778

Enrollment: 210 Email: [email protected] Address:

UPHP Legal Entity Address: 228 W. Washington Street 228 W. Washington Street City:

Marquette City: Marquette State: MI


Legal Entity Name: USABLE MUTUAL INSURANCE

COMPANY Contract Number: H4213 Organization Marketing Name: ARKANSAS BLUE CROSS AND

BLUE SHIELD Parent Organization: USAble Mutual

Insurance Company

Organization Type: PFFS Plan Type: PFFS



Legal Entity Address: 601 GAINES STREET

City: LITTLE ROCK State: AR

Zip: 72201

Contact Title: Manager Medicare Operations Name: Kathryn Thornhill Phone: 1-501-379-2787



Address: 320 W. Capitol, Suite 400

City: Little Rock State: AR


Legal Entity Name: USABLE MUTUAL INSURANCE

COMPANY Contract Number: H8091 Organization Marketing Name: ARKANSAS BLUE CROSS AND

BLUE SHIELD Parent Organization: USAble Mutual

Insurance Company

Organization Type: Local CCP Contact Title: Manager Medicare Operations Plan Type: Local PPO Name: Kathryn Thornhill



Address: 320 W. Capitol, Suite 400 Legal Entity Address: 601 Gaines Street



Legal Entity Name: VALIR PACE FOUNDATION

Contract Number: H7114 Organization Marketing Name: Valir PACE Foundation Parent

Organization: Valir Health LLC

Organization Type: National PACE Contact Title: PACE Director Plan Type: National PACE Name: Brandy Bailey



Address: 700 NW 7th St Legal Entity Address: 721 NW 6th Street

City: Oklahoma City City: Oklahoma City State: OK

State: OK Zip: 73102


Zip: 73102 Last Updated: 12/30/2013 Legal Entity Name: VANTAGE HEALTH PLAN, INC.

Contract Number: H5576 Organization Marketing Name: Vantage Health Plan, Inc.

Parent Organization: Vantage Holdings, Inc.

Organization Type: Local CCP Contact Title: Medicare Compliance Officer Plan Type: HMO/HMOPOS Name: Sally L Knight



Address: 130 DeSiard St Legal Entity Address: 130 DeSiard St Suite 300

Suite 300 City: Monroe City: Monroe State: LA


Legal Entity Name: VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS Contract Number:

H1714 Organization Marketing Name: Via Christi HOPE

Parent Organization: Via Christi Outreach Pgrm. Elders, Inc Organization Type: National PACE Contact Title: CEO PACE Plan Type: National PACE Name: Karen

Sturchio Contract Effective Date: 09/01/2002 Phone: 1-316-858-1111 Tax Status: Not-for-Profit/Non-Profit Extension:


Address: 2622 W Central, Suite 101 Legal Entity Address: 2622 W. Central - Suite 101

City: Wichita City: WICHITA State: KS State: KS Zip: 67203 Zip: 67203 Last Updated: 04/22/2014

Legal Entity Name: VIECARE BEAVER LLC DBA LIFE

BEAVER COUNTY Contract Number: H7660 Organization Marketing Name: LIFE Beaver and Lawrence

Counties Parent Organization: Lutheran SeniorLife

Organization Type: National PACE Contact Title: Director of MIS Plan Type: National PACE Name: Dean Phillips



Address: Lutheran SeniorLife Legal Entity Address: 191 Scharberry Ln 191 Scharberry Lane

City: Mars City: Mars State: PA


Legal Entity Name: VIECARE BUTLER, LLC Contract Number: H3060

Organization Marketing Name: LIFE Butler County Parent Organization: Lutheran SeniorLife

Organization Type: National PACE Contact Title: Director of MIS Plan Type: National PACE Name: Dean Phillips


CMS Region Responsible: Philadelphia Fax: 1-724-772-2960


Enrollment: 135 Email: [email protected] Address: Lutheran

SeniorLife Legal Entity Address: 231 West Diamond St 191 Scharberry Lane City: Mars

City: Butler State: PA State: PA Zip: 16046

Zip: 16001 Last Updated: 01/21/2014 Legal Entity Name: VILLAGE SENIOR SERVICES

CORPORATION Contract Number: H9345 Organization Marketing Name: VillageCareMAX Full Advantage

FIDA Parent Organization: Village Care of New York, Inc.

Organization Type: Demo Contact Title: Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Provider Services



Address: PO Box 5536 Legal Entity Address: 112 Charles Street

City: Hauppauge City: New York State: NY


Legal Entity Name: VIRGINIA PREMIER HEALTH PLAN, INC.

Contract Number: H3067 Organization Marketing Name: Virginia Premier CompleteCare

Parent Organization: Virginia Cwlth University Hlth System

Authority

Organization Type: Demo Contact Title: [email protected] Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Rebecca Jones



Address: 600 East Broad Street Legal Entity Address: 600 East Broad Street Suite 400

Suite 400 City: Richmond City: Richmond State: VA


Legal Entity Name: VISTA HEALTH PLAN, INC. Contract

Number: H4227 Organization Marketing Name: Vista Health Plan, Inc.


Organization Type: Local CCP Contact Title: Director Medicare Customer Service & Oversight Plan Type: HMO/HMOPOS Name: Geoffrey Vitrano


CMS Region Responsible: Philadelphia Fax: Enrollment: 3,403 Email: [email protected] Address:

Amerihealth Caritas Family of Companies Legal Entity Address: 1901 Market St 200 Stevens Dr City: Philadelphia

City: Philadelphia State: PA State: PA Zip: 19113



Legal Entity Name: VIVA HEALTH, INC. Contract Number: H0154

Organization Marketing Name: VIVA Medicare Parent Organization: UAB Health System

Organization Type: Local CCP Contact Title: Manager of Sales and Marketing Operations Plan Type: HMO/HMOPOS Name: Tony Ceasar


CMS Region Responsible: Atlanta Fax: 1-205-393-1748 Enrollment: 45,532 Email: [email protected] Address: 417 20th Street

North Legal Entity Address: 417 20th Street North Suite 1100

Suite 1100 City: Birmingham City: BIRMINGHAM State: AL

State: AL Zip: 35203 Zip: 35203 Last Updated: 07/01/2013

Legal Entity Name: VNS CHOICE Contract Number: H5549

Organization Marketing Name: VNSNY CHOICE Medicare Parent Organization: Visiting Nurse Service of New York

Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Sandra Osse



Address: 1250 Broadway Legal Entity Address: 107 E 70th Street 11th Floor



Legal Entity Name: VNS CHOICE Contract Number: H8490

Organization Marketing Name: VNSNY CHOICE FIDA Complete Parent Organization: Visiting Nurse Service of New York

Organization Type: Demo Contact Title: Communications Specialist Plan Type: Medicare-Medicaid Plan HMO/HMOPOS Name: Sandra Osse



Address: 1250 Broadway Legal Entity Address: 107 East 70th Street 11th Floor



Legal Entity Name: VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC. Contract

Number: H6787 Organization Marketing Name: Senior Community Care of Michigan

Parent Organization: Volunteers of America National Services


Organization Type: National PACE Contact Title: Vice President of Information Technology Plan Type: National PACE Name: David Osborne


Extension: CMS Region Responsible: Philadelphia Fax: 1-952-941-0428 Enrollment: 22 Email: [email protected]

Address: 7530 Market Place Dr. Legal Entity Address: 1921 East Miller Road

City: Eden Prairie City: Lansing State: MN State: MI Zip: 55344 Zip: 48911 Last Updated: 09/10/2014

Legal Entity Name: VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC Contract Number: H0839 Organization Marketing Name: Senior CommUnity Care of North Carolina


Organization Type: National PACE Contact Title: Billing Office Manager Plan Type: National PACE Name: Kippir Westbrook

Contract Effective Date: 07/01/2013 Phone: 1-919-425-3000 Tax Status: Not-for-Profit/Non-Profit Extension: CMS Region Responsible: Atlanta Fax: 1-919-425-3001 Enrollment: 110 Email: [email protected]

Address: 4022 Stirrup Creek Suite 315 Legal Entity Address: 4022 Stirrup Creek Drive Suite 315

City: Durham City: Durham State: NC State: NC Zip: 27703 Zip: 27703 Last Updated: 03/15/2013

Legal Entity Name: VOLUNTEER STATE HEALTH PLAN

Contract Number: H3259 Organization Marketing Name: BlueCare Plus Tennessee

Parent Organization: BlueCross BlueShield of Tennessee




Address: 1 Cameron Hill Circle, Legal Entity Address: 1 Cameron Hill Circle



Legal Entity Name: VOLUNTEERS OF AMERICA NATIONAL

SERVICES Contract Number: H2815 Organization Marketing Name: Senior CommUnity Care of Colorado






Legal Entity Address: 2377 Robins Way

City: Montrose State: CO

Zip: 81401

Contact Title: Business Office Manager Name: Jeanette Curtis Phone: 1-970-252-0522


Email: [email protected] Address: 2377 Robins Way

City: Montrose State: CO


Legal Entity Name: WABASH MEMORIAL HOSPITAL

ASSOCIATION Contract Number: H6140 Organization Marketing Name: Wabash Mem. Hospital

Parent Organization: Wabash Memorial Hospital Association

Organization Type: HCPP - 1833 Cost Contact Title: Admin. Plan Type: HCPP - 1833 Cost Name: Tamara Bivins



Address: 1340 N. Water St Legal Entity Address: 1501 NORTH WATER ST. PO Box 1340 City:

Decatur City: DECATUR State: IL


Legal Entity Name: WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC Contract Number:

H9730 Organization Marketing Name: WellCare

Parent Organization: WellCare Health Plans, Inc. Organization Type: Local CCP Contact Title: Plan Type: HMO/HMOPOS Name: Website Inquiries

Contract Effective Date: 01/01/2013 Phone: 1-888-888-9355 Tax Status: For Profit Extension: CMS Region Responsible: Atlanta Fax: Enrollment: 7,339 Email: [email protected]

Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: 8735 Henderson Road

City: Tampa City: Tampa State: FL State: FL Zip: 33634 Zip: 33634 Last Updated: 09/19/2014

Legal Entity Name: WELLCARE HEALTH INSURANCE OF

ARIZONA, INC. Contract Number: H2491 Organization Marketing Name: 'Ohana Health Plan





Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: 8735 Henderson Rd

Ren 1 City: Tampa City: Tampa State: FL



Legal Entity Name: WELLCARE HEALTH PLANS OF NEW

JERSEY, INC. Contract Number: H0913 Organization Marketing Name: WellCare





Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: P.O. Box 26011



Legal Entity Name: WELLCARE OF CONNECTICUT, INC.

Contract Number: H0712 Organization Marketing Name: WellCare





Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: 116 WASHINGTON AVENUE

City: Tampa City: NORTH HAVEN State: FL


Legal Entity Name: WELLCARE OF

FLORIDA, INC. Contract Number: H1032 Organization Marketing Name: WellCare



Plan Type: HMO/HMOPOS Name: Website Inquiries


Tax Status: For Profit Extension:


Enrollment: 107,624 Email: [email protected] Address: 8735 Henderson Road, Ren 1, 3rd Floor

Legal Entity Address: 8735 Henderson Road City: Tampa

City: TAMPA State: FL

State: FL Zip: 33634




GEORGIA, INC. Contract Number: H1112 Organization Marketing Name: WellCare



Plan Type: HMO/HMOPOS Name: Website Inquiries


Tax Status: For Profit Extension:


Enrollment: 34,719 Email: [email protected] Address: 8735 Henderson Road, Ren 1, 3rd Floor

Legal Entity Address: 8735 Henderson Rd Ren 1

City: Tampa

City: Tampa State: FL

State: FL Zip: 33634



LOUISIANA, INC. Contract Number: H1903 Organization Marketing Name: WellCare





Legal Entity Address: 8735 Henderson Rd Ren 1

City: Tampa State: FL Zip: 33634

Contact Title: Name: Website Inquiries Phone: 1-888-888-


Address: 8735 Henderson Road, Ren 1, 3rd Floor



Legal Entity Name: WELLCARE OF NEW YORK,

INC. Contract Number: H2751 Organization Marketing Name: WellCare Advocate

Complete FIDA Parent Organization: WellCare

Health Plans, Inc.


HMO/HMOPOS Name: Website Inquiries



Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: 8735 Henderson Road




Legal Entity Name: WELLCARE OF NEW YORK,

INC. Contract Number: H3361 Organization Marketing Name: WellCare





Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: P.O.BOX 1652

City: Tampa City: NEWBURGH State: FL


Legal Entity Name: WELLCARE OF TEXAS, INC.

Contract Number: H1264 Organization Marketing Name: WellCare





Address: 8735 Henderson Road, Ren 1, 3rd Floor Legal Entity Address: 8735 Henderson Rd

Ren 1 City: Tampa City: Tampa State: FL


Legal Entity Name: WINDSOR HEALTH PLAN,

INC. Contract Number: H5698 Organization Marketing Name: WellCare





Legal Entity Address: 7100 Commerce Way, Ste

285

City: Brentwood State: TN

Zip: 37027

Contact Title: Name: Website Inquiries Phone: 1-888-888-9355


Address: 8735 Henderson Road, Ren 1, 3rd Floor



September 2015 Contract Directory Sorted by Legal Entity Name Page 168 of 168

plan directory for medicare advantage, cost, pace,...

Documents